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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Options to Purchase Common Stock | $ 4.8 | 11/02/2015 | A | 120,000 | 11/02/2016(2) | 11/02/2025 | Common Stock | 120,000 | $ 0 | 120,000 | D | ||||
Options to Purchase Common Stock | $ 39.4 | 07/12/2012 | J(3) | 3,000 | 11/02/2015(3) | 07/12/2022 | Common Stock | 3,000 | (3) | 3,000 | D | ||||
Options to Purchase Common Stock | $ 7.5 | 12/08/2014 | J(3) | 1,000 | 11/02/2015(3) | 12/08/2024 | Common Stock | 1,000 | (3) | 1,000 | D | ||||
Options to Purchase Common Stock | $ 19.9 | 07/03/2014 | J(3) | 1,200 | 11/02/2015(3) | 07/03/2024 | Common Stock | 1,200 | (3) | 1,200 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Vidwans Smruti J. 400 S. AUSTRALIAN AVE., SUITE 800 WEST PALM BEACH, FL 33401 |
Chief Science Officer |
/s/ Smruti Vidwans | 11/30/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Reflects the one-for-ten reverse stock split effectuated by Rennova Health, Inc. ("Rennova"). |
(2) | The Option shall vest with respect to fifty percent (50%) of the total number of shares of Common Stock (the "Shares") subject to the Option on the six-month anniversary of the date of grant, and the remaining fifty percent (50%) of the total number of Shares subject to the Option on the twelve-month anniversary, subject to the Reporting Person's continued status as an employee on each applicable vesting date, such that all Shares subject to the Option shall be fully vested on the first anniversary of the date of grant of the Option. |
(3) | In connection with the merger transaction with Medytox Solutions, Inc., and the one-for-ten reverse stock split effectuated by Rennova, the Options, which were previously reported, have been adjusted to reflect accelerated vesting; an adjustment to the number of Options and the number of shares of common stock issuable upon exercise of the Options; and an adjustment to the exercise price as a consequence of the reverse split. |