0001096906-17-000065.txt : 20170202 0001096906-17-000065.hdr.sgml : 20170202 20170202172737 ACCESSION NUMBER: 0001096906-17-000065 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170131 FILED AS OF DATE: 20170202 DATE AS OF CHANGE: 20170202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ACTIVECARE, INC. CENTRAL INDEX KEY: 0001429896 STANDARD INDUSTRIAL CLASSIFICATION: COMMUNICATIONS EQUIPMENT, NEC [3669] IRS NUMBER: 870578125 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 1365 WEST BUSINESS PARK DRIVE, SUITE 100 CITY: OREM STATE: UT ZIP: 84058 BUSINESS PHONE: 877-219-6050 MAIL ADDRESS: STREET 1: 1365 WEST BUSINESS PARK DRIVE, SUITE 100 CITY: OREM STATE: UT ZIP: 84058 FORMER COMPANY: FORMER CONFORMED NAME: Volu-Sol Reagents CORP DATE OF NAME CHANGE: 20080317 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PETERSON JEFFREY S CENTRAL INDEX KEY: 0001575497 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-53570 FILM NUMBER: 17569447 MAIL ADDRESS: STREET 1: 539 EAST BLACKHAWK LN CITY: ALPINE STATE: UT ZIP: 84004 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2017-01-31 0 0001429896 ACTIVECARE, INC. ACAR 0001575497 PETERSON JEFFREY S 539 EAST BLACKHAWK LN ALPINE UT 84004 1 1 1 0 CEO Series G Preferred Stock 2017-01-31 4 A 0 32415 A Common Stock 32415 D A class of Series G Convertible Preferred Stock ("Series G") was created on January 31, 2017. Mr. Peterson was issued 32,415 shares of Series G stock. The Series G automatically converts into common stock only upon the happening of certain specified events. Each share of Series G has a stated value of $500. The Series G converts into common stock at the stated value of such shares at the time of conversion. /s/ Jeffrey S. Peterson 2017-02-02