0001415889-18-000258.txt : 20180216 0001415889-18-000258.hdr.sgml : 20180216 20180216153633 ACCESSION NUMBER: 0001415889-18-000258 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20171231 FILED AS OF DATE: 20180216 DATE AS OF CHANGE: 20180216 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KATZAROFF JAMES C CENTRAL INDEX KEY: 0001286868 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-53497 FILM NUMBER: 18621028 MAIL ADDRESS: STREET 1: C/O ADVANCED MEDICAL ISOTOPE CORP. STREET 2: 1021 N. KELLOGG STREET CITY: KENNEWICK STATE: WA ZIP: 99336 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: VIVOS INC CENTRAL INDEX KEY: 0001449349 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 800138937 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 719 JADWIN AVENUE CITY: RICHLAND STATE: WA ZIP: 99352 BUSINESS PHONE: 509-736-4000 MAIL ADDRESS: STREET 1: 719 JADWIN AVENUE CITY: RICHLAND STATE: WA ZIP: 99352 FORMER COMPANY: FORMER CONFORMED NAME: ADVANCED MEDICAL ISOTOPE Corp DATE OF NAME CHANGE: 20081103 5 1 form5-02162018_120218.xml X0306 5 2017-12-31 1 0 1 0001449349 VIVOS INC RDGL 0001286868 KATZAROFF JAMES C C/O VIVOS INC 719 JADWIN AVENUE RICHLAND WA 99352 true false false false Common Stock 2017-02-02 4 C 0 1545400 0.50 A 1064246 D Common Stock 2017-05-31 4 A 0 600000 A 600540 I By Spouse Common Stock 2017-07-21 4 A 0 1500000 A 1064246 D Common Stock 2017-03-30 4 S 0 35000 0.13 D 1064246 D Common Stock 2017-03-31 4 S 0 10000 0.14 D 1064246 D Common Stock 2017-04-07 4 S 0 10000 0.12 D 1064246 D Common Stock 2017-04-11 4 S 0 30000 0.13 D 1064246 D Common Stock 2017-04-17 4 S 0 10000 0.12 D 1064246 D Common Stock 2017-04-20 4 S 0 10000 0.12 D 1064246 D Common Stock 2017-04-28 4 S 0 10000 0.11 D 1064246 D Common Stock 2017-04-28 4 S 0 5000 0.11 D 1064246 D Common Stock 2017-05-01 4 S 0 33859 0.12 D 1064246 D Common Stock 2017-05-02 4 S 0 20000 0.11 D 1064246 D Common Stock 2017-05-04 4 S 0 15000 0.11 D 1064246 D Common Stock 2017-05-17 4 S 0 10000 0.10 D 1064246 D Common Stock 2017-05-23 4 S 0 25000 0.10 D 1064246 D Common Stock 2017-05-24 4 S 0 10000 0.12 D 1064246 D Common Stock 2017-06-06 4 S 0 20000 0.09 D 1064246 D Common Stock 2017-07-21 4 S 0 25000 0.08 D 1064246 D Common Stock 2017-07-24 4 S 0 25000 0.08 D 1064246 D Common Stock 2017-07-25 4 S 0 20000 0.08 D 1064246 D Common Stock 2017-08-07 4 S 0 23016 0.07 D 1064246 D Common Stock 2017-08-30 4 S 0 11882 0.07 D 1064246 D Common Stock 2017-09-05 4 S 0 22141 0.07 D 1064246 D Common Stock 2017-09-11 4 S 0 22000 0.07 D 1064246 D Common Stock 2017-09-15 4 S 0 15000 0.06 D 1064246 D Common Stock 2017-09-19 4 S 0 10000 0.06 D 1064246 D Common Stock 2017-09-20 4 S 0 15000 0.07 D 1064246 D Common Stock 2017-09-29 4 S 0 25000 0.08 D 1064246 D Common Stock 2017-10-09 4 S 0 15000 0.08 D 1064246 D Series A Convertible Preferred Stock 0.50 2017-02-02 4 C 0 154540 0 D 2016-04-15 Common Stock 1545400 150000 D Series A Convertible Preferred Stock 0.50 2017-05-31 4 A 0 10000 A 2016-04-15 Common Stock 100000 10000 I By Spouse Series A Convertible Preferred Stock 0.50 2017-07-21 4 A 0 150000 A 2016-04-15 Common Stock 1500000 150000 D Shares issued to Reporting Person's spouse as payment of $66,092.56 owed for services rendered to the Issuer prior to Ms. Katzaroff's resignation. Shares issued to Reporting Person as payment of $206,071.51 owed for services rendered to the Issuer prior to the Reporting Person's resignation. See Exhibit 99.1 for additional transactions. The Series A Convertible Preferred Stock has no expiration date. /s/ James C. Katzaroff 2018-02-16 EX-24 2 ex24-02162018_120222.htm Untitled Document
 
 
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.
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
OMB APPROVAL
 ________________________________________
 
OMB Number:                                    3235-0362
Estimated average burden
hours per response:                       1.0
 
1. Name and Address of Reporting Person*
KATZAROFF JAMES C.
 
2. Issuer Name and Ticker or Trading Symbol 
VIVOS INC. [RDGL]   
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
  X   Director
  (Last)            (First)            (Middle)
 
C/O VIVOS INC
719 JADWIN AVENUE
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2017
 
    __  10% Owner
     __   Officer (give title below)
    __  Other (specify below)
 
  (Street)
 
RICHLAND           WA           99352
 
(City)                                (State)                     (Zip)
4. If Amendment, Date Original Filed (Month/Day/Year) 
6. Individual or Joint/Group Filing (Check Applicable Line)
 
  X   Form filed by One Reporting Person
        Form filed by More than One Reporting Person
 
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security(Instr. 3)
2. Transaction Date (Month/Day/Year)
2A. Deemed Execution Date, if any (Month/Day/Year)
3. Transaction Code(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)(Instr. 3, 4 and 5)   
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
7. Nature of Indirect Beneficial Ownership (Instr. 4)
 
 
 
 
Amount
(A) or
(D)
Price
 
 
 
     (Form 5, continued)
 
 
 
 
 
 
 
 
 
 
   Common Stock
   10/11/2017
 
 S4
 3,076
 D
 $0.07
  1,064,246
 D
 
   Common Stock
   10/12/2017
 
 S4
 18,000
 D
 $0.07
  1,064,246
 D
 
 
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g., puts, calls, warrants, options, convertible securities)
 
1. Title of Derivate Security(Instr. 3)
2. Conversion or Exercise Price of Derivative Security
3. Transaction Date
3A. Deemed Execution Date, if any
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  
7. Title and Amount of Securities Underlying Derivative Security(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)
 
 
 
 
 
  (A)
  (D)
  Date
 Exercisable
 Expiration
 Date
  Title
 Amount or Number of Shares
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Explanation of Responses:
 
 
/s/ James C. Katzaroff
** Signature of Reporting Person
02/16/2018
Date
 
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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.