0001181431-11-044217.txt : 20110805
0001181431-11-044217.hdr.sgml : 20110805
20110805173044
ACCESSION NUMBER: 0001181431-11-044217
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20110803
FILED AS OF DATE: 20110805
DATE AS OF CHANGE: 20110805
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Backus John C
CENTRAL INDEX KEY: 0001362651
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015163
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015161
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015162
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015160
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015167
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015165
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015166
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: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-13117
FILM NUMBER: 111015164
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
4
1
rrd319272.xml
FORM 4
X0304
4
2011-08-03
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
1
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
2011-08-03
4
P
0
408798
3.50
A
1956941
D
Common Stock
2011-08-03
4
P
0
4585
3.50
A
21947
D
Common Stock
2011-08-03
4
P
0
15189
3.50
A
72708
D
Common Stock
2011-08-03
4
P
0
423987
3.50
A
2029649
I
See Footnote
Common Stock
2011-08-03
4
P
0
428572
3.50
A
2051596
I
See Footnote
Common Stock
2011-08-03
4
P
0
428572
3.50
A
2051596
I
See Footnote
Common Stock
2011-08-03
4
P
0
423987
3.50
A
2029649
I
See Footnote
Common Stock
2011-08-03
4
P
0
423987
3.50
A
2029649
I
See Footnote
On August 3, 2011, New Atlantic Venture Fund III, L.P., NAV Managers Fund, LLC and New Atlantic Entrepreneur Fund, L.P. purchased directly from the Issuer, 408,798, 4,585 and 15,189 shares of the Issuer's Common Stock, respectively.
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 shares of Common Stock held indirectly by New Atlantic Fund III, LLC (the "General Partner"), the General Partner of Fund III and Entrepreneur Fund.
Represents 1,956,941 shares of Common Stock held indirectly by Mr. Backus in Fund III, 72,708 shares of Common Stock held indirectly by Mr. John Backus in Entrepreneur Fund, and 21,947 shares of Common Stock held indirectly by Mr. Backus in NAV LLC.
Represents 1,956,941 shares of Common Stock held indirectly by Mr. Hixon in Fund III, 72,708 shares of Common Stock held indirectly by Mr. Todd Hixon in Entrepreneur Fund, and 21,947 shares of Common Stock held indirectly by Mr. Hixon in NAV LLC.
Represents 1,956,941 shares of Common Stock held indirectly by Mr. Johnson in Fund III, and 72,708 shares of Common Stock held indirectly by Mr. Scott Johnson in Entrepreneur Fund.
Represents 1,956,941 shares of Common Stock held indirectly by Mr. Delistathis in Fund III, and 72,708 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. Irrevocable 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 LLC. 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, New Atlantic Fund III, LLC (General Partner) for New Atlantic Venture Fund III, L.P.
2011-08-05
/s/ Todd L. Hixon, Member for NAV Managers Fund, LLC
2011-08-05
/s/ John C. Backus, Managing Member, New Atlantic Fund III, LLC (General Partner) for New Atlantic Entrepreneur Fund III, L.P.
2011-08-05
/s/ John C. Backus, Managing Member for New Atlantic Fund III, LLC
2011-08-05
/s/ John C. Backus
2011-08-05
/s/ Todd L. Hixon
2011-08-05
/s/ Scott M. Johnson
2011-08-05
/s/ Thanasis Delistathis
2011-08-05