0001019687-16-006127.txt : 20160505
0001019687-16-006127.hdr.sgml : 20160505
20160505155116
ACCESSION NUMBER: 0001019687-16-006127
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160502
FILED AS OF DATE: 20160505
DATE AS OF CHANGE: 20160505
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Rennova Health, Inc.
CENTRAL INDEX KEY: 0000931059
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-COMPUTER PROCESSING & DATA PREPARATION [7374]
IRS NUMBER: 680370244
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 400 S. AUSTRALIAN AVENUE, SUITE 800
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
BUSINESS PHONE: 561-855-1626
MAIL ADDRESS:
STREET 1: 400 S. AUSTRALIAN AVENUE, SUITE 800
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
FORMER COMPANY:
FORMER CONFORMED NAME: CollabRx, Inc.
DATE OF NAME CHANGE: 20120926
FORMER COMPANY:
FORMER CONFORMED NAME: TEGAL CORP /DE/
DATE OF NAME CHANGE: 19950918
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Mendolia Thomas Francis DO
CENTRAL INDEX KEY: 0001575762
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35141
FILM NUMBER: 161623468
MAIL ADDRESS:
STREET 1: 400 SOUTH AUSTRALIAN AVENUE
STREET 2: 8TH FLOOR
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
4
1
mendolia_frm4.xml
FORM 4
X0306
4
2016-05-02
1
0000931059
Rennova Health, Inc.
RNVA
0001575762
Mendolia Thomas Francis DO
400 S. AUSTRALIAN AVENUE
8TH FLOOR
WEST PALM BEACH
FL
33401
0
0
1
0
Options to Purchase Common Stock
1.00
2016-05-02
4
A
0
20000
0
A
2026-05-02
Common Stock
20000
20000
D
Options to Purchase Common Stock
5.00
2016-05-02
4
A
0
1000000
0
A
2016-05-02
2017-12-31
Common Stock
1000000
1000000
D
Options to Purchase Common Stock
10.00
2016-05-02
4
A
0
1000000
0
A
2016-05-02
2022-12-31
Common Stock
1000000
1000000
D
The options vest as follows: 5,000 upon date of grant, 5,000 on June 30, 2016, 5,000 on September 30, 2016, and 5,000 on December 31, 2016, subject to the Reporting Person's attendance at meetings of the Issuer's scientific advisory committee.
/s/ Thomas Francis Mendolia
2016-05-05