Initial Statement of Beneficial Ownership (3)
July 09 2018 - 10:32AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Sandgaard Thomas
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2. Date of Event Requiring Statement (MM/DD/YYYY)
7/9/2018
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3. Issuer Name
and
Ticker or Trading Symbol
ZYNEX INC [ZYXI]
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(Last)
(First)
(Middle)
C/O ZYNEX, INC.,, 9555 MAROON CIRCLE
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
President, CEO and Chairman /
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(Street)
ENGLEWOOD, CO 80112
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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2129571
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D
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Common Stock
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15200000
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I
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Held by Sandgaard Holdings LLC
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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. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Option to Purchase Common Stock
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10/31/2014
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10/31/2023
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A
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190000
(1)
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$0.22
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D
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Option to Purchase Common Stock
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1/2/2016
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1/2/2026
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A
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203571
(2)
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$0.14
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D
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Option to Purchase Common Stock
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12/14/2018
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12/14/2027
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A
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1000
(3)
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$2.76
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D
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Explanation of Responses:
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(1)
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Represents options to purchase 190,000 shares of the Issuer's common stock issued pursuant to the Zynex Medical Holdings Inc. 2005 Stock Option Plan (the "2005 Plan") which have vested in full.
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(2)
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Represents options to purchase 203,571 shares of common stock issued pursuant to the 2005 Plan which have vested in full.
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(3)
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Represents options to purchase 1,000 shares of common stock issued on December 14, 2017 pursuant to the Issuer's 2017 Stock Incentive Plan of which no options are vested and which total options vest in four equal annual installments beginning on the one year anniversary of the issue date.
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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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Sandgaard Thomas
C/O ZYNEX, INC.,
9555 MAROON CIRCLE
ENGLEWOOD, CO 80112
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X
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President, CEO and Chairman
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Sandgaard Holdings LLC
C/O ZYNEX, INC.,
9555 MAROON CIRCLE
ENGLEWOOD, CO 80112
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X
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Signatures
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/s/ Thomas Sandgaard
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7/9/2018
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**
Signature of Reporting Person
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Date
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/s/ Sandgaard Holdings LLC
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7/9/2018
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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 5(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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