0001209191-11-046902.txt : 20110907 0001209191-11-046902.hdr.sgml : 20110907 20110907155605 ACCESSION NUMBER: 0001209191-11-046902 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110902 FILED AS OF DATE: 20110907 DATE AS OF CHANGE: 20110907 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILLER LLOYD I III CENTRAL INDEX KEY: 0000949119 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-13117 FILM NUMBER: 111078226 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 4 1 doc4.xml FORM 4 SUBMISSION X0304 4 2011-09-02 0 0000754813 HealthWarehouse.com, Inc. HEWA 0000949119 MILLER LLOYD I III 4550 GORDON DRIVE NAPLES FL 34102 0 0 1 0 Warrant 2.90 2011-09-02 2011-09-02 4 A 0 250000 0.00 A 2011-09-02 2016-09-02 Common Stock 250000 250000 I By Milfam I L.P. Warrant 1.60 2009-12-15 2014-12-15 Common Stock 156250 156250 I By Milfam I L.P. Warrant 1.60 2010-05-03 2015-05-03 Common Stock 156250 156250 I By Milfam I L.P. Series B Preferred Stock 0.00 2010-11-08 Common Stock 828870 828870 I By Milfam I L.P. 7% Senior Secured Convertible Promissory Note 0.00 2010-11-08 2012-12-31 Common Stock 267290 267290 I By Milfam I L.P. Warrant 3.00 2010-11-08 2015-11-08 Common Stock 585808 585808 I By Milfam I L.P. The reporting person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. This filing shall not be deemed an admission that the reporting person is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any equity securites covered by this filing. The reporting person holds 165,774 shares of Series B Preferred Stock. This amount includes 1,660 shares of Series B Preferred Stock received by the reporting person as a dividend for the year 2010. Each share of Series B Preferrred Stock is immediately convertible into 5 shares of common stock. N/A The convertible note is immediately convertible into 53,458 shares of Series B Preferred Stock. Each share of Series B Preferred Stock is immediately convertible into 5 shares of common stock. This amount includes a $5,178.00 interest payment on January 1, 2011 received for the year 2010. /s/ Paul N. Silverstein Attorney-in-fact 2011-09-07