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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Convertible Promissory Note (3) | $ 0.1 | 08/10/2017 | C(1) | $ 150,000 | 11/10/2016 | 11/10/2017 | Common Stock | 1,500,000 | $ 0 | 0 | D | ||||
Convertible Promissory Note (3) | $ 0.1 | 08/10/2017 | C(2) | $ 250,000 | 02/24/2017 | 08/24/2017 | Common Stock | 2,500,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Opko Health, Inc. 4400 BISCAYNE BLVD. MIAMI, FL 33137 |
X |
Adam Logal, Chief Financial Officer | 08/14/2017 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Pursuant to the terms of the Convertible Note, the Reporting Person acquired (i) 1,500,000 shares of Common Stock upon conversion of $150,000 in principal amount of the Convertible Note, and (ii) 63,123 shares of Common Stock in accrued and previously unpaid interest thereon ($6,312.33). |
(2) | Pursuant to the terms of the Convertible Note, the Reporting Person acquired (i) 2,500,000 shares of Common Stock upon conversion of $250,000 in principal amount of the Convertible Note, and (ii) 63,699 shares of Common Stock in accrued and previously unpaid interest thereon (6,369.86). |
(3) | The derivative security was previously subject to a "blocker" pursuant to which the reporting person was unable to convert the derivative security to the extent such conversion would result in the reporting person owning more than 4.99%. |