Statement of Changes in Beneficial Ownership (4)
May 07 2021 - 1:23PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Korenko Michael K |
2. Issuer Name and Ticker or Trading Symbol
VIVOS INC
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RDGL
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
CEO AND PRESIDENT |
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(Last)
(First)
(Middle)
C/O VIVOS INC, 719 JADWIN AVENUE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/3/2021 |
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(Street)
RICHLAND,, WA 99352
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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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 | 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 Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Restricted Stock Units | (1) | 5/3/2021 | | A | | 15000000 | | (2) | (2) | Common Stock | 15000000 | $0 | 15000000 | D | |
| Restricted Stock Units | (1) | 5/3/2021 | | A | | 15000000 | | (3) | (3) | Common Stock | 15000000 | $0 | 15000000 | D | |
| Explanation of Responses: |
| (1) | Each restricted stock unit represents a contingent right to receive one share of common stock. |
| (2) | Represents grant of time based restricted stock units. The time based restricted stock units vest in three equal installments beginning on the date of the grant and on the two anniversaries of the grant date thereafter, subject to the Reporting P erson's continued employment. Unless the reporting person defers delivery of the Vested Shares, the Vested shares will be delivered to the Reporting P erson in equal installments in each calendar quarter following the vesting date. |
| (3) | Represents grant of performance based restricted stock units. The performance based restricted stock units vest in three equal installments on the nine month, eighteen month, and twenty-seven month anniversaries of the grant date, based on achievement of certain performance goals and subject to the Reporting P erson's continued employment. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Korenko Michael K
C/O VIVOS INC
719 JADWIN AVENUE
RICHLAND,, WA 99352 |
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| CEO AND PRESIDENT |
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Signatures
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| /s/ Michael K. Korenko | | 5/7/2021 |
| **Signature of Reporting Person | Date |
Vivos (QB) (USOTC:RDGL)
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