FORM 5
[X] Check box if no longer subject to
Section 16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
[ ] Form 3 Holdings
Reported.
[X] Form 4 Transactions
Reported.
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UNITED STATES SECURITIES AND EXCHANGE
COMMISSION
Washington, D.C.
20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP
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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OMB APPROVAL
________________________________________
OMB
Number:
3235-0362
Estimated average burden
hours per
response:
1.0
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1.
Name and Address of Reporting Person*
KATZAROFF JAMES
C.
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2. Issuer
Name and Ticker or Trading Symbol
VIVOS
INC.
[RDGL]
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5.
Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X
Director
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(Last)
(First)
(Middle)
C/O VIVOS
INC
719 JADWIN
AVENUE
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year)
12/31/2017
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__ 10%
Owner
__ Officer (give
title below)
__ Other (specify
below)
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(Street)
RICHLAND
WA
99352
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(Month/Day/Year)
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6.
Individual or Joint/Group Filing (Check Applicable Line)
X
Form filed by One Reporting Person
Form filed by More than One Reporting Person
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Table I - Non-Derivative
Securities Acquired, Disposed of, or Beneficially
Owned
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1.Title of Security(Instr.
3)
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2. Transaction Date
(Month/Day/Year)
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2A. Deemed Execution Date,
if any (Month/Day/Year)
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3. Transaction Code(Instr.
8)
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4. Securities Acquired (A)
or Disposed of (D)(Instr. 3, 4 and 5)
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5. Amount of Securities
Beneficially Owned Following Reported Transaction(s)(Instr. 3 and
4)
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6. Ownership Form: Direct
(D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect
Beneficial Ownership (Instr. 4)
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Amount
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(A)
or
(D)
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Price
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(Form 5,
continued)
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Common
Stock
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10/11/2017
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S4
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3,076
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D
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$0.07
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1,064,246
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D
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Common
Stock
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10/12/2017
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S4
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18,000
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D
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$0.07
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1,064,246
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D
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1. Title of Derivate Security(Instr.
3)
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2. Conversion or Exercise Price of Derivative
Security
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3. Transaction
Date
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3A. Deemed Execution Date, if
any
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4. Transaction Code(Instr.
8)
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5. Number of Derivative Securities Acquired
(A) or Disposed of (D)(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying
Derivative Security(Instr. 3 and 4)
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8. Price of Derivative Security(Instr.
5)
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9. Number of Derivative Securities
Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form of Derivative Security:
Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership
(Instr. 4)
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(A)
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(D)
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Date
Exercisable
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Expiration
Date
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Title
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Amount or Number of
Shares
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Explanation
of Responses:
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/s/ James C.
Katzaroff
** Signature of
Reporting Person
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02/16/2018
Date
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Reminder: Report on a
separate line for each class of securities beneficially owned
directly or indirectly.
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*
If the form is filed by more than one reporting person,
see Instruction 4
(b)(v).
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**
Intentional misstatements or omissions of facts constitute Federal
Criminal Violations See 18
U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note: File three copies of
this Form, one of which must be manually signed. If space is
insufficient, see
Instruction 6 for procedure.
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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
Number.
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