-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, FhC4SkUfp8ISeeUToZiLEYbSZYgFmsVt4AKyw41NkyZaVlQNYbE5KDrW7N9FOl0d m5F+PY6a5WcgvDTzdjh7mg== 0001181431-11-002217.txt : 20110106 0001181431-11-002217.hdr.sgml : 20110106 20110106171521 ACCESSION NUMBER: 0001181431-11-002217 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101231 FILED AS OF DATE: 20110106 DATE AS OF CHANGE: 20110106 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Backus John C CENTRAL INDEX KEY: 0001362651 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514944 MAIL ADDRESS: STREET 1: DRAPER ATLANTIC STREET 2: 11911 FREEDOM DRIVE, SUITE 1080 CITY: RESTON STATE: VA ZIP: 20191 FORMER NAME: FORMER CONFORMED NAME: Backus John G DATE OF NAME CHANGE: 20060512 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Johnson Scott M CENTRAL INDEX KEY: 0001504806 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514942 MAIL ADDRESS: STREET 1: 11911 FREEDOM DRIVE STREET 2: SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Hixon Todd L CENTRAL INDEX KEY: 0001504832 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514943 MAIL ADDRESS: STREET 1: 11911 FREEDOM DRIVE STREET 2: SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Delistathis Thanasis CENTRAL INDEX KEY: 0001504834 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514941 MAIL ADDRESS: STREET 1: 11911 FREEDOM DRIVE STREET 2: SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HealthWarehouse.com, Inc. CENTRAL INDEX KEY: 0000754813 STANDARD INDUSTRIAL CLASSIFICATION: RETAIL-DRUG STORES AND PROPRIETARY STORES [5912] IRS NUMBER: 222413505 STATE OF INCORPORATION: DE FISCAL YEAR END: 1202 BUSINESS ADDRESS: STREET 1: 100 COMMERCE BOULEVARD CITY: CINCINNATI, STATE: OH ZIP: 45140 BUSINESS PHONE: (513) 618-0911 MAIL ADDRESS: STREET 1: 100 COMMERCE BOULEVARD CITY: CINCINNATI, STATE: OH ZIP: 45140 FORMER COMPANY: FORMER CONFORMED NAME: HealthWarehouse, Inc. DATE OF NAME CHANGE: 20090818 FORMER COMPANY: FORMER CONFORMED NAME: CLACENDIX, INC. DATE OF NAME CHANGE: 20080107 FORMER COMPANY: FORMER CONFORMED NAME: ION NETWORKS INC DATE OF NAME CHANGE: 19990413 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NEW ATLANTIC VENTURE FUND III L P CENTRAL INDEX KEY: 0001372004 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514948 BUSINESS ADDRESS: STREET 1: 11911 FREEDOM DRIVE, SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 BUSINESS PHONE: 703-563-4105 MAIL ADDRESS: STREET 1: 11911 FREEDOM DRIVE, SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NEW ATLANTIC ENTREPRENEUR FUND III LP CENTRAL INDEX KEY: 0001403951 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514946 BUSINESS ADDRESS: STREET 1: 11911 FREEDOM DRIVE SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 BUSINESS PHONE: 703-563-4105 MAIL ADDRESS: STREET 1: 11911 FREEDOM DRIVE SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NAV MANAGERS FUND LLC CENTRAL INDEX KEY: 0001422350 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514947 BUSINESS ADDRESS: STREET 1: 11911 FREEDOM DRIVE STREET 2: SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 BUSINESS PHONE: (703) 563-4105 MAIL ADDRESS: STREET 1: 11911 FREEDOM DRIVE STREET 2: SUITE 1080 CITY: RESTON STATE: VA ZIP: 20190 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NEW ATLANTIC FUND III LLC CENTRAL INDEX KEY: 0001422519 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 11514945 BUSINESS ADDRESS: STREET 1: 11911 FREEDOM DRIVE STREET 2: #1080 CITY: RESTON STATE: VA ZIP: 20190 BUSINESS PHONE: 703-563-4105 MAIL ADDRESS: STREET 1: 11911 FREEDOM DRIVE STREET 2: #1080 CITY: RESTON STATE: VA ZIP: 20190 3 1 rrd296927.xml FORM 3 X0203 3 2010-12-31 0 0000754813 HealthWarehouse.com, Inc. HEWA 0001372004 NEW ATLANTIC VENTURE FUND III L P 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 1 0 0001422350 NAV MANAGERS FUND LLC 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 0 1 Member of 10% Group 0001403951 NEW ATLANTIC ENTREPRENEUR FUND III LP 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 0 1 Member of 10% Group 0001422519 NEW ATLANTIC FUND III LLC 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 1 0 0001362651 Backus John C 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 1 0 0001504832 Hixon Todd L 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 1 0 0001504806 Johnson Scott M 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 1 0 0001504834 Delistathis Thanasis 11911 FREEDOM DRIVE, SUITE 1080 RESTON VA 20190 0 0 1 0 Common Stock 1548143 D Common Stock 17362 D Common Stock 57519 D Common Stock 1605662 I See Footnote Common Stock 1623024 I See Footnote Common Stock 1623024 I See Footnote Common Stock 1605662 I See Footnote Common Stock 1605662 I See Footnote Represents shares owned directly by New Atlantic Venture Fund III, L.P. ("Fund III"). Represents shares owned directly by NAV Managers Fund, LLC ("NAV LLC"). Represents shares owned directly by New Atlantic Entrepreneur Fund, L.P. ("Entrepreneur Fund"). Represents 1,605,662 shares of Common Stock held indirectly by the New Atlantic Fund III, LLC ("General Partner"), the General Partner of Fund III and Entrepreneur Fund. Represents 1,548,143 shares of Common Stock held indirectly by Mr. Backus in Fund III, 57,519 shares of Common Stock held indirectly by Mr. John Backus in Entrepreneur Fund, and 17,362 shares of Common Stock held indirectly by Mr. Backus in NAV LLC. Represents 1,548,143 shares of Common Stock held indirectly by Mr. Hixon in Fund III, 57,519 shares of Common Stock held indirectly by Mr. Todd Hixon in Entrepreneur Fund, and 17,362 shares of Common Stock held indirectly by Mr. Hixon in NAV LLC. Represents 1,548,143 shares of Common Stock held indirectly by Mr. Johnson in Fund III, and 57,519 shares of Common Stock held indirectly by Mr. Scott Johnson in Entrepreneur Fund. Represents 1,548,143 shares of Common Stock held indirectly by Mr. Delistathis in Fund III, and 57,519 shares of Common Stock held indirectly by Mr. Thanasis Delistathis in Entrepreneur Fund. This is a joint filing by (i) New Atlantic Venture Fund III, L.P., a Delaware limited partnership ("Fund III"), (ii) NAV Managers Fund, LLC, a Delaware limited liability company ("NAV LLC"), an affiliate of Fund III which is member managed, (iii) New Atlantic Entrepreneur Fund III, L.P., a Delaware limited partnership ("Entrepreneur Fund"), an affiliate of Fund III, (iv) New Atlantic Fund III, LLC, a Delaware limited liability company ("General Partner"), the general partner of Fund III and Entrepreneur Fund; (v) John C. Backus, a United States Citizen ("Backus"), (vi) Todd L. Hixon ("Hixon"), a United States citizen, (vii) Scott M. Johnson ("Johnson"), a United States citizen and (viii) Thanasis Delistathis ("Delistathis"), a United States citizen. Messrs. Backus, Hixon, Johnson and Delistathis are the managing members of the General Partner. Mr. Hixon and Mr. Backus, as trustee of the John C. Backus, Jr. Irre vocable Trust, are members of NAV LLC. Messrs. Backus, Hixon, Johnson and Delistathis, share voting and investment control over all securities owned by Fund III, Entrepreneur Fund and the General Partner. The John C. Backus, Jr. Irrevocable Trust, John C. Backus, Trustee and Todd Hixon share voting and investment control over the securities owned by NAV. Each of Messrs. Backus, Hixon, Johnson and Delistathis disclaim beneficial ownership of the shares held directly by Fund III, the General Partner and Entrepreneur Fund except to the extent of their pecuniary interest therein. Messrs. Backus and Hixon disclaim beneficial ownership of the shares held directly by NAV LLC, except to the extent of their pecuniary interest therein. The General Partner disclaims beneficial ownership of shares held directly by Fund III and Entrepreneur Fund except to the extent of its pecuniary interest therein. /s/ John C. Backus, Managing Member for New Atlantic Venture Fund III, L.P. New Atlantic Fund III, LLC (General Partner) 2011-01-06 /s/ Todd L. Hixon, Member for NAV Managers Fund, LLC 2011-01-06 /s/ John C. Backus, Managing Member for New Atlantic Entrepreneur Fund III, L.P. New Atlantic Fund III, LLC (General Partner) 2011-01-06 /s/ John C. Backus, Managing Member for New Atlantic Fund III, LLC 2011-01-06 /s/ John C. Backus 2011-01-06 /s/ Todd L. Hixon 2011-01-06 /s/ Scott M. Johnson 2011-01-06 /s/ Thanasis Delistathis 2011-01-06 -----END PRIVACY-ENHANCED MESSAGE-----