Statement of Changes in Beneficial Ownership (4)
September 02 2014 - 7:11PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
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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
*
Dalrymple Peter L
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2. Issuer Name
and
Ticker or Trading Symbol
Spine Pain Management, Inc
[
SPIN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
13451 BELHAVEN DRIVE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
7/26/2013
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(Street)
HOUSTON, TX 77069
(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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Common Stock
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7/26/2013
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P
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5000
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A
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$0.28
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1553936
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I
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See Footnote
(1)
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Common Stock
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7/26/2013
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P
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6360
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A
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$0.3
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1560296
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I
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See Footnote
(1)
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Common Stock
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7/26/2013
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P
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3000
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A
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$0.3
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1563296
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I
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See Footnote
(1)
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Common Stock
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7/29/2013
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P
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2000
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A
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$0.35
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1565296
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I
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See Footnote
(1)
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Common Stock
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7/29/2013
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P
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8000
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A
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$0.35
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1573296
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I
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See Footnote
(1)
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Common Stock
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7/29/2013
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P
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10000
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A
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$0.35
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1583296
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I
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See Footnote
(1)
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Common Stock
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7/30/2013
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P
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30000
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A
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$0.31
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1613296
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I
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See Footnote
(1)
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Common Stock
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8/12/2013
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P
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4340
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A
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$0.35
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1617636
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I
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See Footnote
(1)
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Common Stock
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8/12/2013
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P
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4000
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A
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$0.35
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1621636
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I
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See Footnote
(1)
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Common Stock
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8/16/2013
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P
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5000
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A
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$0.33
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1626636
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I
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See Footnote
(1)
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Common Stock
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8/16/2013
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P
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2500
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A
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$0.33
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1629136
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I
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See Footnote
(1)
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Common Stock
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8/16/2013
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P
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17500
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A
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$0.33
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1646636
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I
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See Footnote
(1)
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Common Stock
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8/19/2013
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P
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5000
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A
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$0.38
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1651636
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I
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See Footnote
(1)
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Common Stock
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8/19/2013
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P
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20000
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A
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$0.38
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1671636
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I
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See Footnote
(1)
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Common Stock
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8/22/2013
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P
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2000
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A
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$0.32
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1673636
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I
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See Footnote
(1)
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Common Stock
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8/22/2013
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P
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23000
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A
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$0.32
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1696636
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I
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See Footnote
(1)
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Common Stock
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9/6/2013
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P
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10500
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A
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$0.29
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1707136
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I
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See Footnote
(1)
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Common Stock
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9/6/2013
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P
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3294
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A
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$0.31
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1710430
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I
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See Footnote
(1)
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Common Stock
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9/6/2013
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P
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36206
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A
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$0.31
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1746636
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I
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See Footnote
(1)
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Common Stock
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12/30/2013
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P
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5000
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A
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$0.53
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1751636
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I
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See Footnote
(1)
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Common Stock
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12/31/2013
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P
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5000
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A
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$0.51
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1756636
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I
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See Footnote
(1)
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Common Stock
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12/31/2013
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P
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5000
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A
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$0.51
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1761636
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I
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See Footnote
(1)
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(
1)
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Shares are held by LPD Investments Ltd. Mr. Dalrymple is General Partner of LPD Investment Ltd. and has voting and investment authority over shares held by it. He is also a Limited Partner of LPD Investment Ltd. with the other Limited Partners being his wife and three trusts, of which he is trustee and his children are beneficiaries.
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Remarks:
Mr. Dalrymple did not become a director until August 20, 2014.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Dalrymple Peter L
13451 BELHAVEN DRIVE
HOUSTON, TX 77069
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X
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X
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Signatures
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/s/ Peter L. Dalrymple
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9/2/2014
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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