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