Statement of Changes in Beneficial Ownership (4)
November 02 2021 - 7:29PM
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).
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
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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
*
Johnson Scott Mitchell |
2. Issuer Name and Ticker or Trading Symbol
PetVivo Holdings, Inc.
[
PETV
]
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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)
5251 EDINA INDUSTRIAL BLVD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/4/2021 |
(Street)
EDINA,, MN 55439
(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 | 5/4/2021 | | S | | 100 | D | $8.85 | 14001 | I | By spouse |
Common Stock | 5/4/2021 | | S | | 90 | D | $8.70 | 13911 | I | By spouse |
Common Stock | 5/5/2021 | | S | | 2115 | D | $7.75 | 11796 | I | By spouse |
Common Stock | 5/10/2021 | | S | | 271 | D | $8.50 | 11525 | I | By spouse |
Common Stock | 5/10/2021 | | S | | 950 | D | $8.55 | 10575 | I | By spouse |
Common Stock | 8/13/2021 | | P | | 4000 | A | $4.50 (1) | 14575 | I | By spouse |
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 |
Warrants | $5.625 | 8/13/2021 | | P | | 4000 | | 8/10/2021 | 8/10/2026 | Common Stock | 4000 | $4.50 (1) | 4000 | I | By spouse |
Explanation of Responses: |
(1) | Represents the purchase price for one unit, which consists of one shares of the Company's common stock and one warrant to purchase one shares of the company's common stock, which is exercisable beginning on or after February 9, 2022 and ending August 16, 2026. The Reporting Person realized short-swing profits under Section 16(b) of the Exchange Act as a result of the purchase of the Issuer's securities by the Reporting Person's wife matched against sales of securities by the Reporting Person's wife as reported herein. On November 1, 2021, the Reporting Person disgorged $12,618.26 to the Issuer, represented the short-swing profits realized by the Reporting Person as a result of such transactions. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Johnson Scott Mitchell 5251 EDINA INDUSTRIAL BLVD EDINA,, MN 55439 | X |
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Signatures
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/s/ Scott M. Johnson | | 11/2/2021 |
**Signature of Reporting Person | Date |
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