0001493152-18-018080.txt : 20181228 0001493152-18-018080.hdr.sgml : 20181228 20181228171649 ACCESSION NUMBER: 0001493152-18-018080 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181228 FILED AS OF DATE: 20181228 DATE AS OF CHANGE: 20181228 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Rudelius Robert James CENTRAL INDEX KEY: 0001403679 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55167 FILM NUMBER: 181258049 MAIL ADDRESS: STREET 1: 6913 ARBOR LANE CITY: MCCLEAN STATE: VA ZIP: 22101 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PetVivo Holdings, Inc. CENTRAL INDEX KEY: 0001512922 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 990363559 STATE OF INCORPORATION: NV FISCAL YEAR END: 0331 BUSINESS ADDRESS: STREET 1: 5251 EDINA INDUSTRIAL BLVD CITY: EDINA STATE: MN ZIP: 55439 BUSINESS PHONE: (952) 217-4952 MAIL ADDRESS: STREET 1: 5251 EDINA INDUSTRIAL BLVD CITY: EDINA STATE: MN ZIP: 55439 FORMER COMPANY: FORMER CONFORMED NAME: Technologies Scan Corp DATE OF NAME CHANGE: 20110211 4 1 ownership.xml X0306 4 2018-12-28 0 0001512922 PetVivo Holdings, Inc. PETV 0001403679 Rudelius Robert James 5251 EDINA INDUSTRIAL BLVD EDINA MN 55439 1 0 0 0 Common Stock 2018-12-10 4 X 0 45000 .30 A 226727 D Common Stock 2018-12-10 4 X 0 12500 .30 A 239727 D Common Stock 2018-12-10 4 J 0 19167 .30 A 258394 D Common Stock 2018-12-11 4 O 0 25000 .30 A 283394 D Common Stock 2018-12-11 4 J 0 8333 .30 A 291727 D Common Stock 2018-12-11 4 J 0 172406 51722 A 464133 D Common Stock 2018-12-11 4 O 0 25861 .30 A 489994 D Common Stock 2018-12-11 4 J 0 8621 .30 A 498615 D Common Stock Warrant .30 2018-12-10 4 X 0 45000 .30 D 2017-12-07 2020-12-07 Common Stock 45000 125000 D Common Stock Warrant .30 2018-12-10 4 X 0 12500 D 2018-08-20 2023-08-20 Common Stock 12500 112500 D Common Stock Warrant .30 2018-12-11 4 O 0 25000 50000 D 2018-09-24 2021-09-24 Common Stock 25000 87500 D Common Stock Warrant .30 2018-12-11 4 A 0 25861 51722 A 2018-12-11 2018-12-31 Common Stock 25861 113361 D Common Stock Warrant .30 2018-12-11 4 O 0 25861 51722 D 2018-12-11 2018-12-31 Common Stock 25861 87500 D 100,000 warrants were granted to Robert Rudelius on August 20, 2018 pursuant to his Director Agreement; these warrants vest quarterly over a two-year period in equal tranches of 12,500, have a term of 5 years, and a strike price of $1.00 per warrant. Mr. Rudelius exercised 12,500 warrants that he was granted pursuant to his Director Agreement. These warrants were exercised pursuant to a special, one-time Discounted Warrant Exercise Agreement whereby all warrant-holders were given the option to exercise their warrants at $.30 per warrant on or before December 15th, 2018. A Stock Transfer Agreement was entered into between John Lai and Robert Rudelius pursuant to entering into the Discounted Warrant Exercise Agreement mentioned in note 2 above and called for the transfer of common stock shares from John Lai to Robert Rudelius in the amount of one-third the amount of warrants exercised pursuant to the Discounted Warrant Exercise Agreement; 19,167 shares were transferred to Robert Rudelius from John Lai pursuant to this agreement Pursuant to a Bridge Promissory Note Conversion Agreement, Mr. Rudelius converted $51,721.86 in debt owed to him into 172,406 shares of common stock at a rate of $.30 per share. Pursuant to a Bridge Promissory Note Conversion Agreement, Mr. Rudelius received, and subsequently exercised, 1 warrant for every $2 of the outstanding balance of his Note. The warrants had a strike price of $.30 per warrant, vested immediately, and an expiration date of December 31, 2018. Pursuant to a Bridge Promissory Note Conversion Agreement, Mr. Rudelius entered into a Stock Transfer Agreement whereby he received 8,621 shares of common stock from John Lai; this number was calculated using a 3-to-1 warrant to share issuance rate (1 share was transferred for every 3 warrants exercised). A Stock Transfer Agreement was entered into between John Lai and Robert Rudelius pursuant to entering into the Discounted Warrant Exercise Agreement mentioned in note 2 above and called for the transfer of common stock shares from John Lai to Robert Rudelius in the amount of one-third the amount of warrants exercised pursuant to the Discounted Warrant Exercise Agreement; 8,333 shares were transferred to Robert Rudelius from John Lai pursuant to this agreement. /s/ Robert Rudelius 2018-12-28