Statement of Changes in Beneficial Ownership (4)
June 22 2022 - 5:17PM
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).
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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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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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Holley Danica |
2. Issuer Name and Ticker or Trading Symbol
THERALINK TECHNOLOGIES, INC.
[
THER
]
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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)
9410 BILTMORE DRIVE |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/15/2022 |
(Street)
SILVER SPRING, MD 20901
(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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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 |
8% Convertible Promissory Note | $0.0048 | 6/15/2022 | | J (1) | | $50000 | | 6/29/2022 (2) | 6/1/2027 | Common Stock | 10504202 (3) | $50000 | $50000 | D | |
Warrants (right to buy) | $0.0048 | 6/15/2022 | | J (4) | | 2100840 | | 6/15/2022 | 6/1/2027 | Common Stock | 2100840 | $0 (4) | 2100840 | D | |
Explanation of Responses: |
(1) | The Reporting Person purchased this promissory note from the corporation. |
(2) | The promissory note may be converted at the Reporting Person's election at any time following amendment to the corporation's articles of incorporation with the Secretary of State of the State of Nevada to increase the corporation's authorized stock to 100,000,000,000. This amendment to the corporation's articles of incorporation is expected to be filed on June 29, 2022. Additionally, the promissory note will automatically convert upon the listing or trading of common stock on a qualified national exchange. |
(3) | Excludes shares issuable at the election of the Reporting Person upon conversion of accrued interest (both past and future) into shares of common stock. |
(4) | Granted to the Reporting Person as warrant coverage in connection with the convertible promissory note reported on this Table II. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Holley Danica 9410 BILTMORE DRIVE SILVER SPRING, MD 20901 | X |
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Signatures
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/s/ Danica Holley | | 6/22/2022 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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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