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