0001209191-12-036317.txt : 20120702
0001209191-12-036317.hdr.sgml : 20120702
20120702181956
ACCESSION NUMBER: 0001209191-12-036317
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20120628
FILED AS OF DATE: 20120702
DATE AS OF CHANGE: 20120702
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: 12941546
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: 1231
BUSINESS ADDRESS:
STREET 1: 7107 INDUSTRIAL ROAD
CITY: FLORENCE
STATE: KY
ZIP: 41042
BUSINESS PHONE: (513) 618-0911
MAIL ADDRESS:
STREET 1: 7107 INDUSTRIAL ROAD
CITY: FLORENCE
STATE: KY
ZIP: 41042
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
X0306
4
2012-06-28
0
0000754813
HealthWarehouse.com, Inc.
HEWA
0000949119
MILLER LLOYD I III
222 LAKEVIEW AVENUE
SUITE 160-365
WEST PALM BEACH
FL
33401
0
0
1
0
Common Stock
2012-06-28
4
X
0
156250
1.60
A
156250
I
By Milfam I L.P.
Common Stock
2012-06-28
4
X
0
156250
1.60
A
312500
I
By Milfam I L.P.
Common Stock
2012-06-28
4
X
0
585808
3.00
A
898308
I
By Milfam I L.P.
Common Stock
2012-06-28
4
X
0
250000
2.90
A
1148308
I
By Milfam I L.P.
Common Stock
2012-06-28
4
S
0
38343
6.74
D
1109965
I
By Milfam I L.P.
Common Stock
2012-06-28
4
S
0
38343
6.74
D
1071622
I
By Milfam I L.P.
Common Stock
2012-06-28
4
S
0
251419
6.99
D
820203
I
By Milfam I L.P.
Common Stock
2012-06-28
4
S
0
103719
6.99
D
716484
I
By Milfam I L.P
Warrant
2.90
2012-06-28
2012-06-28
4
X
0
250000
0.00
D
2011-09-02
2016-09-02
Common Stock
250000
0
I
By Milfam I L.P.
Warrant
1.60
2012-06-28
2012-06-28
4
X
0
156250
0.00
D
2009-12-15
2014-12-15
Common Stock
156250
0
I
By Milfam I L.P.
Warrant
1.60
2012-06-28
2012-06-28
4
X
0
156250
0.00
D
2010-05-03
2015-05-03
Common Stock
156250
0
I
By Milfam I L.P.
Series B Preferred Stock
0.00
2010-11-08
Common Stock
886895
886895
I
By Milfam I L.P.
7% Senior Secured Convertible Promissory Note
0.00
2010-11-08
2012-12-31
Common Stock
292620
292620
I
By Milfam I L.P.
Warrant
3.00
2012-06-28
2012-06-28
4
X
0
585808
0.00
D
2010-11-08
2015-11-08
Common Stock
585808
0
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 exercised a warrant to purchase 156,250 shares of common stock for the original conversion price of $1.60 per share. The reporting person paid the exercise price on a cashless basis, resulting in the company issuing 117,907 shares of common stock to the reporting person.
The reporting person exercised a warrant to purchase 585,808 shares of common stock for the original conversion price of $3.00 per share. The reporting person paid the exercise price on a cashless basis, resulting in the company issuing 334,389 shares of common stock to the reporting person.
The reporting person exercised a warrant to purchase 250,000 shares of common stock for the original conversion price of $2.90 per share. The reporting person paid the exercise price on a cashless basis, resulting in the company issuing 146,281 shares of common stock to the reporting person.
The reporting person holds 177,379 shares of Series B Preferred Stock. This amount includes 11,605 shares of Series B Preferred Stock received by the reporting person as a dividend for the year 2011. 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 58,524 shares of Series B Preferred Stock which amount includes a $53,048.39 interest payment on the convertible note received through May 8, 2012. Each share of Series B Preferred Stock is immediately convertible into 5 shares of common stock.
/s/ David J. Hoyt
Attorney-in-fact
2012-07-02