0001493152-24-000168.txt : 20240102
0001493152-24-000168.hdr.sgml : 20240102
20240102210652
ACCESSION NUMBER: 0001493152-24-000168
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20231229
FILED AS OF DATE: 20240102
DATE AS OF CHANGE: 20240102
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Breithaupt John Spencer
CENTRAL INDEX KEY: 0001567207
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40715
FILM NUMBER: 24504186
MAIL ADDRESS:
STREET 1: 3041 W. PASADENA DR.
CITY: BOISE
STATE: ID
ZIP: 83705
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: PetVivo Holdings, Inc.
CENTRAL INDEX KEY: 0001512922
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
ORGANIZATION NAME: 08 Industrial Applications and Services
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
X0508
4
2023-12-29
0
0001512922
PetVivo Holdings, Inc.
PETV
0001567207
Breithaupt John Spencer
5251 EDINA INDUSTRIAL BLVD.
EDINA,
MN
55439
1
0
0
0
0
Stock Option (right to buy)
1.06
2023-12-29
4
A
0
30508
0
A
2030-12-28
Common Stock
30508
30508
D
The Options were granted under the PetVivo Holdings, Inc. Amended and Restated 2020 Equity Incentive Plan and vest on the earlier of (i) September 30, 2024, or (ii) the day immediately preceding the next annual meeting of stockholders following the grant date, subject to the Reporting Person's continued service as a director through the vesting date.
/s/ John Spencer Breithaupt
2024-01-02