0001179110-15-012643.txt : 20150826
0001179110-15-012643.hdr.sgml : 20150826
20150826122721
ACCESSION NUMBER: 0001179110-15-012643
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150806
FILED AS OF DATE: 20150826
DATE AS OF CHANGE: 20150826
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ACTIVECARE, INC.
CENTRAL INDEX KEY: 0001429896
STANDARD INDUSTRIAL CLASSIFICATION: COMMUNICATIONS EQUIPMENT, NEC [3669]
IRS NUMBER: 870578125
STATE OF INCORPORATION: DE
FISCAL YEAR END: 0930
BUSINESS ADDRESS:
STREET 1: 1365 WEST BUSINESS PARK DRIVE
CITY: OREM
STATE: UT
ZIP: 84058
BUSINESS PHONE: 877-219-6050
MAIL ADDRESS:
STREET 1: 1365 WEST BUSINESS PARK DRIVE
CITY: OREM
STATE: UT
ZIP: 84058
FORMER COMPANY:
FORMER CONFORMED NAME: Volu-Sol Reagents CORP
DATE OF NAME CHANGE: 20080317
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ADP MANAGEMENT CORP
CENTRAL INDEX KEY: 0001120338
STATE OF INCORPORATION: UT
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53570
FILM NUMBER: 151075235
BUSINESS ADDRESS:
STREET 1: 1401 N HIGHWAY 89
STREET 2: SUITE 240
CITY: FARMINGTON
STATE: UT
ZIP: 84025
BUSINESS PHONE: 801-451-5742
MAIL ADDRESS:
STREET 1: 1401 N HIGHWAY 89
STREET 2: SUITE 240
CITY: FARMINGTON
STATE: UT
ZIP: 84025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DERRICK DAVID G
CENTRAL INDEX KEY: 0000938421
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-53570
FILM NUMBER: 151075236
MAIL ADDRESS:
STREET 1: 1401 NORTH HIGHWAY 89, SUITE 240
CITY: FARMINGTON
STATE: UT
ZIP: 84025
4
1
edgar.xml
FORM 4 -
X0306
4
2015-08-06
0
0001429896
ACTIVECARE, INC.
ACAR
0000938421
DERRICK DAVID G
1401 NORTH 1075 WEST, SUITE 240
FARMINGTON
UT
84025
0
0
1
0
0001120338
ADP MANAGEMENT CORP
1401 N. 1075 W., STE. 240
FARMINGTON
UT
84025
0
0
1
0
Common Stock
2015-08-06
4
J
0
750000
A
10107579
I
By ADP Management Corporation
Common Stock
2015-08-06
4
J
0
737132
D
9370447
I
By ADP Management Corporation
Common Stock
4750
I
By Purizer Corporation
Common Stock
1212500
I
By Schwartz Group, LLC
Common Stock
37006
D
The shares of common stock were issued to David Derrick as a severance payment and in consideration of Mr. Derrick's willingness to continue to guaranty certain obligations of issuer; however, at Mr. Derrick's request, such shares were issued in the name of ADP Management Corporation.
ADP Management Corporation is owned and controlled, in part, by David Derrick. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
The shares of common stock were transferred to third parties pursuant to purchase agreements which contained contingent future obligations to transfer additional shares of common stock to such third parties for no additional consideration.
Purizer Corporation is owned and controlled, in part, by David Derrick. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
Schwartz Group, LLC is owned, in part, by ADP Management Corporation. The Reporting Persons disclaim beneficial ownership of these securities except to the extent of their respective pecuniary interests therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
David G. Derrick
2015-08-26
By: David G. Derrick, Secretary and Treasurer
2015-08-26