0001683168-16-000172.txt : 20160922
0001683168-16-000172.hdr.sgml : 20160922
20160922121543
ACCESSION NUMBER: 0001683168-16-000172
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160921
FILED AS OF DATE: 20160922
DATE AS OF CHANGE: 20160922
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Rennova Health, Inc.
CENTRAL INDEX KEY: 0000931059
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-TESTING LABORATORIES [8734]
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: 161897165
MAIL ADDRESS:
STREET 1: 400 SOUTH AUSTRALIAN AVENUE
STREET 2: 8TH FLOOR
CITY: WEST PALM BEACH
STATE: FL
ZIP: 33401
4
1
mendolia_f4.xml
OWNERSHIP DOCUMENT
X0306
4
2016-09-21
0
0000931059
Rennova Health, Inc.
RNVA
0001575762
Mendolia Thomas Francis DO
400 S. AUSTRALIAN AVENUE, SUITE 800
WEST PALM BEACH
FL
33401
0
0
1
0
Common Stock
2016-09-21
4
C
0
1146789
0
A
3739847
D
Series B Convertible Preferred Stock
2016-09-21
4
C
0
1000
0
D
0
D
Each share of Series B Convertible Preferred Stock was converted, pursuant to its terms, into 1,146.789 shares of Common Stock.
/s/ Thomas Francis Mendolia DO
2016-09-22