0001066152-21-000003.txt : 20210408
0001066152-21-000003.hdr.sgml : 20210408
20210408080548
ACCESSION NUMBER: 0001066152-21-000003
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200924
FILED AS OF DATE: 20210408
DATE AS OF CHANGE: 20210408
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: WAGNER TODD R
CENTRAL INDEX KEY: 0001066152
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36763
FILM NUMBER: 21813821
MAIL ADDRESS:
STREET 1: 3008 TAYLOR ST
CITY: DALLAS
STATE: TX
ZIP: 75226
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FWHC BRIDGE, LLC
CENTRAL INDEX KEY: 0001849773
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36763
FILM NUMBER: 21813820
BUSINESS ADDRESS:
STREET 1: 334 EAST LAKE ROAD
STREET 2: SUITE 176
CITY: PALM HARBOT
STATE: FL
ZIP: 34685
BUSINESS PHONE: 123 456 7890
MAIL ADDRESS:
STREET 1: 334 EAST LAKE ROAD
STREET 2: SUITE 176
CITY: PALM HARBOT
STATE: FL
ZIP: 34685
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: H-CYTE, INC.
CENTRAL INDEX KEY: 0001591165
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 463312262
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 201 E KENNEDY BLVD STE 700
CITY: TAMPA
STATE: FL
ZIP: 33602
BUSINESS PHONE: 844-633-6839
MAIL ADDRESS:
STREET 1: 201 E KENNEDY BLVD STE 700
CITY: TAMPA
STATE: FL
ZIP: 33602
FORMER COMPANY:
FORMER CONFORMED NAME: Medovex Corp.
DATE OF NAME CHANGE: 20140501
FORMER COMPANY:
FORMER CONFORMED NAME: SpineZ
DATE OF NAME CHANGE: 20131105
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2020-09-24
0
0001591165
H-CYTE, INC.
HCYT
0001066152
WAGNER TODD R
3385 OLD KEYSTONE ROAD
TARPON SPRINGS
FL
34688
0
0
1
0
0001849773
FWHC BRIDGE, LLC
334 EAST LAKE ROAD
SUITE 176
PALM HARBOR
FL
34685
0
0
1
0
SERIES A PREFERRED STOCK
2020-09-24
4
J
0
226566264
0.014
A
2020-09-24
COMMON STOCK
226566264
226566264
I
(SEE FOOTNOTE)
STOCK PURCHASE WARRANTS
0.014
2020-09-24
4
J
0
265868613
A
2020-09-24
COMMON STOCK
265868613
265868613
I
(SEE FOOTNOTE)
SERIES A PREFERRED STOCK
2020-09-24
4
J
0
110219286
0.014
A
2020-09-24
COMMON STOCK
110219286
336785550
I
(SEE FOOTNOTE)
Held directly by FWHC Bridge, LLC (Bridge), and indirectly by Todd R. Wagner, the sole manager of Bridge. Each of the reporting persons disclaims beneficial ownership of the securities except to the extent of its or his pecuniary interest therein.
Received upon conversion of variable conversion price notes at closing of Qualified Financing. Note conversion price became fixed at closing. "Price of derivative securities" represents aggregate price paid for debt divided by number of shares received upon conversion of debt. Series A stock is convertible into common stock on a 1:1 basis.
Redeemable at option of requisite number of holders in specified circumstances.
Received in connection with variable conversion price notes. No additional consideration was paid for warrants, Exercise price became fixed at closing of Qualified Financing.
Purchased as part of backstop commitment in Qualified Financing. Series A stock is convertible into common stock on a 1:1 basis.
Not applicable.
/s/ Todd R. Wagner
2021-04-08
/s/ Todd R. Wagner o/b/o FWHC Bridge, LLC
2021-04-08