Statement of Changes in Beneficial Ownership (4)
January 13 2020 - 4:06PM
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
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
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Anderson Justin Eric |
2. Issuer Name and Ticker or Trading Symbol
PreCheck Health Services, Inc.
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HLTY
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Executive Officer |
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(Last)
(First)
(Middle)
W. WOODWARD STREET, SUITE 221 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/17/2019 |
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(Street)
DENISON, TX 75020
(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)
___ Form filed by One Reporting Person
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X
_ 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, par value $0.0001 per share | 12/17/2019 | | J | | 250000 | A | (1) | 525000 | D | |
| Common stock, par value $0.0001 per share | 12/19/2019 | | J | | 1750000 | A | (2) | 2275000 | D | |
| Common stock, par value $0.0001 per share | 12/19/2019 | | J | | 1750000 | A | (2) | 1750000 | I | By Spouse |
| Common stock, par value $0.0001 per share | | | | | | | | 18165 (3) | I | Jointly with 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 |
| Explanation of Responses: |
| (1) | The Company issued 250,000 shares of common stock to Justin Anderson pursuant to his employment agreement dated October 31, 2018. |
| (2) | The Company issued 1,750,000 shares of common stock to each of Justin Anderson and Stacey Anderson, his spouse, in connection with the acquisition ofJAS Practice Management, Inc. on December 19, 2019. Each of Justin Anderson and Stacey Anderson disclaims beneficial ownership in the shares owned by the other. |
| (3) | Represents shares previously jointly owned by Justin Anderson and Stacey Anderson which had not been previously reported. |
Remarks:
This filing on Form 4 is being filed jointly by Justin Anderson and his spouse, Stacey Anderson. Stacey Anderson's address is 305 W. Woodward Street, Suite 221, Denison, TX 75020. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Anderson Justin Eric
W. WOODWARD STREET, SUITE 221
DENISON, TX 75020 | X | X | Chief Executive Officer |
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Anderson Stacey Gibson
PO BOX 241
MILBURN, OK 73450 |
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Signatures
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| /s/ Justin E Anderson | | 1/13/2020 |
| **Signature of Reporting Person | Date |
| /s/ Stacey Anderson | | 1/13/2020 |
| **Signature of Reporting Person | Date |