Annual Statement of Changes in Beneficial Ownership (5)
March 17 2022 - 4:16PM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
[ ]
Form 3 Holdings Reported
[ ]
Form 4 Transactions Reported |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden hours per response...
1.0
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
WITHROW EDWARD W III | 2. Issuer Name and Ticker or Trading SymbolPARALLAX HEALTH SCIENCES, INC. [PRLX] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
|
(Last)
(First)
(Middle)
3415 S SEPULVEDA BLVD, SUITE 1100-1234 | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2021 |
(Street)
LOS ANGELES, CA 90034
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 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. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. 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 |
PREFERRED STOCK (SERIES A) | 9/30/2011 (1) | | J5 (1) | 36339 | A | $2.75 | 399732 | I | By Huntington Chase Financial Group |
PREFERRED STOCK (SERIES A) | 11/6/2021 | | J (2) | 396339 | A | $0 | 796071 | I | By Huntington Chase Financial Group |
PREFERRED STOCK (SERIES A) | 11/6/2021 | | J (3) | 796071 | D | $0 | 0 | I | By Huntington Chase Financial Group |
COMMON STOCK | 11/6/2021 | | J (3) | 15921420 (3) | A | $0 | 72430792 | I | By Huntington Chase LLC |
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. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 (MM/DD/YYYY) | 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 at End of Issuer's Fiscal Year (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 |
STOCK OPTION | $0.25 | 3/31/2021 | | D | | 3000000 (4) | (4) | 12/31/2022 | COMMON STOCK | 3000000 | $0 | 1000000 | I | By Huntington Chase LLC |
Explanation of Responses: |
(1) | Additional Series A Preferred shares acquired; not included in previous Form 5 for the year 12/31/2012. Total Series A Preferred shares held at 12/31/12 = 399,732. |
(2) | Cumulative dividends in kind on Series A Preferred Stock. |
(3) | Conversion of preferred stock into common stock at a ratio of 20 shares of common stock for each share of preferred stock. |
(4) | Unvested stock options canceled upon resignation of Reporting Person. |
Reporting Owners
|
Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
WITHROW EDWARD W III 3415 S SEPULVEDA BLVD SUITE 1100-1234 LOS ANGELES, CA 90034 |
| X |
|
|
Signatures
|
EDWARD W. WITHROW III | | 3/17/2022 |
**Signature of Reporting Person | 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 control number. |
Parallax Health Sciences (CE) (USOTC:PRLX)
Historical Stock Chart
From Apr 2024 to May 2024
Parallax Health Sciences (CE) (USOTC:PRLX)
Historical Stock Chart
From May 2023 to May 2024
Real-Time news about Parallax Health Sciences Inc (CE) (OTCMarkets): 0 recent articles
More Parallax Health Sciences, Inc. News Articles