-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Ea8PdlGxeg7hh72JR8WUsEgJwaEQnccqhjReGmonFXimO3rIjOhyinlNTcizf405 XgHnTFEVWUa7axBYqkllGg== 0001125282-06-006452.txt : 20061020 0001125282-06-006452.hdr.sgml : 20061020 20061020152011 ACCESSION NUMBER: 0001125282-06-006452 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20061018 FILED AS OF DATE: 20061020 DATE AS OF CHANGE: 20061020 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Ivivi Technologies, Inc. CENTRAL INDEX KEY: 0001316925 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 222956711 STATE OF INCORPORATION: NJ FISCAL YEAR END: 0331 BUSINESS ADDRESS: STREET 1: 224 S PEGASUS AVENUE CITY: NORTHVALE STATE: NJ ZIP: 07647 BUSINESS PHONE: 201-784-8268 MAIL ADDRESS: STREET 1: 224 S PEGASUS AVENUE CITY: NORTHVALE STATE: NJ ZIP: 07647 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SILVER JACK CENTRAL INDEX KEY: 0000922714 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33088 FILM NUMBER: 061155428 BUSINESS ADDRESS: BUSINESS PHONE: 2125428201 MAIL ADDRESS: STREET 1: 660 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10021 4 1 form.xml X0202 4 2006-10-18 0001316925 Ivivi Technologies, Inc. II 0000922714 SILVER JACK 660 MADISON AVENUE NEW YORK NY 10021 1 Common Stock, no par value 2006-10-18 4 C 0 516868 5.11 A 516868 I By Trust 6% Unsecured Joint and Several Convertible Promissory Note 5.11 2006-10-18 4 C 0 516868 D 2010-02-10 Common Stock, no par value 516868 0 I By Trust This convertible note, in the principal amount $2,000,000, was automatically converted upon effectiveness of the registration statement (the "Registration Statement") related to an initial public offering of shares of common stock, no par value (the "Common Stock"), of Ivivi Technologies, Inc. This number of shares includes additional shares of Common Stock issuable pursuant to the terms of the convertible note. Under the terms of the convertible note, the number of shares of Common Stock issuable upon conversion of the note increased by 2% for each 30-day period, and portion thereof, after June 30, 2005, that the Registration Statement was not declared effective by the Securities and Exchange Commission. This number of shares does not include up to 24,930 shares of Common Stock issuable as payment of interest under the note, accrued as of the date hereof, which shares may be issued at the election of the noteholder following the effective date of the Registration Statement. Held by Sherleigh Associates Inc. Defined Benefit Pension Plan, a trust of which Mr. Silver is the trustee. /s/ Jack Silver 2006-10-18 -----END PRIVACY-ENHANCED MESSAGE-----