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
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1. Name and Address of Reporting Person*
SELIGA DANIEL JOSEPH

(Last) (First) (Middle)
C/O HEALTHWAREHOUSE.COM, INC.
4107 INDUSTRIAL ROAD

(Street)
FLORENCE KY 41042

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/11/2016
3. Issuer Name and Ticker or Trading Symbol
HealthWarehouse.com, Inc. [ HEWA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
COO and CFO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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)
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
Options to Purchase Common Stock 08/05/2016(1) 08/05/2025 Common Stock 200,000 $0.12 D
Warrants to Purchase Common Stock 09/30/2013 09/30/2018 Common Stock 150,000 $0.12 D
Warrants to Purchase Common Stock 03/28/2014 03/28/2019 Common Stock 150,000 $0.12 D
Warrants to Purchase Common Stock 04/29/2014 04/29/2019 Common Stock 75,000 $0.12 D
Warrants to Purchase Common Stock 03/01/2015 04/01/2020 Common Stock 500,000 $0.1 D
Warrants to Purchase Common Stock 11/11/2015 01/11/2020 Common Stock 250,000 $0.12 D
Explanation of Responses:
1. The options vest one-third a year on each anniversary of the date of grant, commencing on 8/5/2016.
Remarks:
/s/Daniel Joseph Seliga 01/19/2016
** 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.