SEC Form 3
| FORM 3 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
| |||||||||||||||
1. Name and Address of Reporting Person*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 07/23/2016 | 3. Issuer Name and Ticker or Trading Symbol HealthWarehouse.com, Inc. [ HEWA ] | |||||||||||||
| 4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
| |||||||||||||||
| Table I - Non-Derivative Securities Beneficially Owned | |||
|---|---|---|---|
| 1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
| Common Shares | 3,147,527(1) | D(2) | |
| Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
|---|---|---|---|---|---|---|---|
| 1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
| Warrant to Purchase Common Stock | 08/21/2014 | 08/21/2019 | Common Stock | 1,333,334 | 0.3 | D | |
| Explanation of Responses: |
| 1. The Reporting Person ("RP") is filing this report because the RP is a member of a Section 13D group, as disclosed in the Schedule 13D report originally filed with the SEC on August 2, 2016 filed on behalf of the RP and the other members of such group. As of the date of the event requiring this statement, the group beneficially owned an aggregate 19,062,600 shares and consisted of the following: RX Investor Value Corp., Jeffrey T. Holtmeier, GENext, LLC, Robert Smyjunas, Cormag Holdings, Ltd., Mark Douglas Scott, Osgar Holdings, Ltd., Hong Penner, Bruce Bedrick, Patrick Delaney, Stephen J. Weiss, SCW Holdings, LLP, Lynn Peppel, Cape Bear Partners, LLC, Arthur W. Liberati, LFLP, Ltd., Patricia Corona, Estate of Wayne Corona, Vincent Rinaldi, and Brian Ross. The RP disclaims beneficial ownership of the shares held by the other members of such Section 13(d) group except to the extent of the RP's pecuniary interest therein. |
| 2. Mark Douglas Scott is the president, sole stockholder and a director of Cormag Holdings, Ltd. Both Mark Scott and Cormag Holdings, Ltd. are deemed to be beneficial owners of more than 10% of the Issuer's common stock. The address of Mark Scott is the same as Cormag Holdings, Ltd. |
| /s/ Mark Douglas Scott as President of Cormag Holdings Ltd. | 08/23/2016 | |
| ** 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 5 (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. | ||