SEC Form 4
FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
| |||||||||||||||
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Zivo Bioscience, Inc. [ ZIVO ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| ||||||||||||||||||||||||
3. Date of Earliest Transaction (Month/Day/Year) 04/28/2015 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 04/28/2015 | P | 299,400 | A | $0.1331 | 1,540,527 | D |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) | 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: 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 | ||||||||
Common Stock Purchase Warrant | $0.15 | 09/19/2014 | P | 166,667 | 09/19/2014 | 09/19/2019(4) | Common Stock | 166,667 | (2) | 38,090,000 | D(1) | ||||
Common Stock Purchase Warrant | $0.1 | 12/08/2014 | P | 84,700 | 12/08/2014 | 12/08/2019(4) | Common Stock | 84,700 | (2) | 38,174,700 | D(1) | ||||
Common Stock Purchase Warrant | $0.1 | 02/27/2015 | P | 227,500 | 02/27/2015 | 02/27/2019(4) | Common Stock | 227,500 | (2) | 38,402,200 | D(1) | ||||
Common Stock Purchase Warrant | $0.1 | 03/27/2015 | P | 135,000 | 03/27/2015 | 03/27/2019(4) | Common Stock | 135,000 | (2) | 38,537,200 | D(1) | ||||
Common Stock Purchase Warrant | $0.1 | 04/15/2015 | P | 155,000 | 04/15/2015 | 04/15/2019(4) | Common Stock | 155,000 | (2) | 38,692,200 | D(1) | ||||
Common Stock Purchase Warrant | $0.1 | 04/17/2015 | P | 62,800 | 04/17/2015 | 04/17/2019(4) | Common Stock | 62,800 | (2) | 38,755,000 | D(1) | ||||
Convertible Debt | $0.15 | 09/19/2014 | P | 1,666,667 | 09/19/2014 | 09/19/2016(4) | Common Stock | 1,666,667 | $250,000 | 40,421,667 | D(1) | ||||
Convertible Debt | $0.1 | 12/08/2014 | P | 847,000 | 12/08/2014 | 12/08/2016(4) | Common Stock | 847,000 | $84,700 | 41,268,667 | D(1) | ||||
Convertible Debt | $0.1 | 02/27/2015 | P | 2,275,000 | 02/27/2015 | 02/27/2017(4) | Common Stock | 2,275,000 | $227,500 | 43,543,667 | D(1) | ||||
Convertible Debt | $0.1 | 03/27/2015 | P | 1,350,000 | 03/27/2015 | 03/27/2017(4) | Common Stock | 1,350,000 | $135,000 | 44,893,667 | D(1) | ||||
Convertible Debt | $0.1 | 04/15/2015 | P | 1,550,000 | 04/15/2015 | 04/15/2017(4) | Common Stock | 1,550,000 | $155,000 | 46,443,667 | D(1) | ||||
Convertible Debt | $0.1 | 04/17/2015 | P | 628,000 | 04/17/2015 | 04/17/2017(4) | Common Stock | 628,000 | $62,800 | 47,071,667 | D(1) | ||||
Accrued Interest converting into Common Stock | (5) | 04/28/2015 | P | 7,774,165 | 12/02/2011 | 04/17/2017(4) | Common Stock | 7,774,165 | (3) | 54,845,832 | D(1) |
Explanation of Responses: |
1. HEP Investments has sold participation interests to certain persons in such securities and none of these persons, individually, owns an interest in more than 5% of the Issuer's Common Stock, except for Christopher D. Maggiore, who owns more than a 5% interest in the Issuer's Common Stock. |
2. These warrants are for that number of securities which correspond to the number of securities for the corresponding tranche of convertible debt held by the Reporting Person pursuant to the Sixth Amended and Restated Senior Secured Promissory Note delivered by the Issuer to the Reporting Person (the "Convertible Note"). |
3. This represents paid-in-kind interest on the Convertible Debt already held by the Reporting Person. |
4. Unless the maturity date of the respective tranches are extended beyond these expiration dates by the Reporting Person pursuant to the terms of the Convertible Note. |
5. $.10 to $.30 |
/s/ Laith Yaldoo | 04/30/2015 | |
** 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 Number. |