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