Statement of Changes in Beneficial Ownership (4)
June 29 2021 - 9:20AM
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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OMB APPROVAL
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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
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Ichim Thomas |
2. Issuer Name and Ticker or Trading Symbol
CREATIVE MEDICAL TECHNOLOGY HOLDINGS, INC.
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CELZ
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
211 E. OSBORN RD. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/28/2021 |
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(Street)
PHOENIX, AZ 85012
(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 | 6/28/2021 | | M | | 10000000 | A | $0.004 | 10000000 | D | |
| Common Stock (1) | 6/28/2021 | | F | | 1120448 | D | $0.0357 | 8879552 | D | |
| Common Stock | | | | | | | | 17245 | I (2) | By LLC |
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 |
| Warrant to Purchase Common Stock | $0.004 | 6/28/2021 | | M | | | 10000000 | 12/28/2020 | 12/28/2030 | Common Stock | 10000000 | $0.00 | 0.00 | D | |
| Explanation of Responses: |
| (1) | Reflects 1,120,448 shares of common stock withheld by issuer at a market price of $0.0357 per share to fund the cashless exercise of 10,000,000 shares of common stock acquired upon exercise of the Warrant identified in Table II. |
| (2) | Shares are held by BioTech Holdings, LLC, of which the reporting person is President. The reporting person disclaims beneficial ownership of such shares of common stock except to the extent of his pecuniary interest therein. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Ichim Thomas
211 E. OSBORN RD.
PHOENIX, AZ 85012 | X |
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Signatures
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| /s/ Thomas Ichim | | 6/29/2021 |
| **Signature of Reporting Person | Date |