0001493152-21-024487.txt : 20211004 0001493152-21-024487.hdr.sgml : 20211004 20211004152506 ACCESSION NUMBER: 0001493152-21-024487 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211001 FILED AS OF DATE: 20211004 DATE AS OF CHANGE: 20211004 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: 001-40715 FILM NUMBER: 211302348 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 2021-10-01 0 0001512922 PetVivo Holdings, Inc. PETV 0001403679 Rudelius Robert James 5251 EDINA INDUSTRIAL BLVD EDINA, MN 55439 1 0 0 0 Common Stock 2021-10-01 4 A 0 8333 0.00 A 189997 D These shares will vest and be issued with respect to 4,167 shares on October 1, 2021 and 4,166 shares will vest on March 31, 2022, pursuant to restricted stock units granted to the Reporting Person for Board services pursuant to the PetVivo Holdings, Inc. 2020 Equity Incentive Plan ("2020 Plan"). Includes 8,333 shares that will be issued over time subject to vesting pursuant to the restricted stock units granted under the 2020 Plan. /s/ ROBERT RUDELIUS 2021-10-04