0001493152-21-020536.txt : 20210818 0001493152-21-020536.hdr.sgml : 20210818 20210818154751 ACCESSION NUMBER: 0001493152-21-020536 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210817 FILED AS OF DATE: 20210818 DATE AS OF CHANGE: 20210818 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Huntsman Ronald Kirk CENTRAL INDEX KEY: 0001835498 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39796 FILM NUMBER: 211186637 MAIL ADDRESS: STREET 1: 9137 RIDGELINE BOULEVARD, SUITE 135 CITY: HIGHLANDS RANCH STATE: CO ZIP: 80129 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Vivos Therapeutics, Inc. CENTRAL INDEX KEY: 0001716166 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 813224056 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 9137 RIDGELINE BOULEVARD STREET 2: SUITE 135 CITY: HIGHLANDS RANCH STATE: CO ZIP: 80129 BUSINESS PHONE: (866)908-4867 MAIL ADDRESS: STREET 1: 9137 RIDGELINE BOULEVARD STREET 2: SUITE 135 CITY: HIGHLANDS RANCH STATE: CO ZIP: 80129 FORMER COMPANY: FORMER CONFORMED NAME: Vivos BioTechnologies, Inc. DATE OF NAME CHANGE: 20170901 4 1 ownership.xml X0306 4 2021-08-17 0 0001716166 Vivos Therapeutics, Inc. VVOS 0001835498 Huntsman Ronald Kirk 9137 S. RIDGELINE BLVD, SUITE 135 HIGHLANDS RANCH CO 80129 1 1 0 0 Chief Executive Officer Common Stock 2021-08-17 4 P 0 5000 3.00 A 10500 D Common Stock 1740000 I See footnote Stock Option (Right to Buy) 1.65 2022-09-30 Common Stock 333334 333334 D Shares held by Coronado V Partners, LLC, of which the reporting person is a member and manager. The option provides for vesting in five equal annual installments beginning on January 15, 2017. /s/ Brad Amman as attorney-in-fact for R. Kirk Huntsman 2021-08-18