0001683168-16-000819.txt : 20161130 0001683168-16-000819.hdr.sgml : 20161130 20161130203719 ACCESSION NUMBER: 0001683168-16-000819 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160921 FILED AS OF DATE: 20161130 DATE AS OF CHANGE: 20161130 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: Roca Francisco III CENTRAL INDEX KEY: 0001575722 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35141 FILM NUMBER: 162026549 MAIL ADDRESS: STREET 1: 400 SOUTH AUSTRALIAN AVENUE STREET 2: 8TH FLOOR CITY: WEST PALM BEACH STATE: FL ZIP: 33401 4 1 roca_frm4.xml OWNERSHIP DOCUMENT X0306 4 2016-09-21 0 0000931059 Rennova Health, Inc. RNVA 0001575722 Roca Francisco III 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/ Francisco Roca, III 2016-11-30