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4//SEC Filing

Backus John C 4

Accession 0001209191-11-052776

CIK 0000754813other
View on SEC.govCompany Profile

Filed

Oct 25, 8:00 PM ET

Accepted

Oct 26, 6:59 PM ET

Size

40.8 KB

Accession

0001209191-11-052776

Insider Transaction Report

Form 4
Period: 2011-10-17
HealthWarehouse.com, Inc.HEWA
NEW ATLANTIC VENTURE FUND III L P
10% Owner
Transactions
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
Holdings

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112
Johnson Scott M
10% Owner
Transactions
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
Holdings

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893
Delistathis Thanasis
10% Owner
Transactions
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
Holdings

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112
NAV MANAGERS FUND LLC
Other
Transactions
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
Holdings

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112
NEW ATLANTIC ENTREPRENEUR FUND III LP
Other
Transactions
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
Holdings

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000
NEW ATLANTIC FUND III LLC
10% Owner
Transactions
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
Holdings

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000
Backus John C
Director10% Owner
Transactions
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
Holdings

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112
Hixon Todd L
10% Owner
Transactions
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+354$35,400→ 354 total
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+107$10,700→ 107 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+9,568→ 9,568 total
    Exercise: $2.90→ Common Stock (9,568 underlying)
  • Purchase

    Series C Non Convertible Preferred Stock

    2011-10-17$100.00/sh+9,539$953,900→ 9,539 total
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+257,544→ 257,544 total
    Exercise: $2.90→ Common Stock (257,544 underlying)
  • Award

    Warrant to Purchase Common Stock (Right to buy)

    2011-10-17+2,888→ 2,888 total
    Exercise: $2.90→ Common Stock (2,888 underlying)
Holdings

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    10,000

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (270,000 underlying)
    270,000

  • Warrant to Purchase Common Stock (Right to buy)

    (indirect: See Footnote)
    → Common Stock (267,112 underlying)
    267,112

  • Series C Non Convertible Preferred Stock

    (indirect: See Footnote)
    9,893
Footnotes (18)
  • [F1]On October 17, 2011, New Atlantic Venture Fund III, L.P, a Delaware limited partnership ("Fund III"), New Atlantic Entrepreneur Fund, L.P., a Delaware limited partnership ("Entrepreneur Fund") and NAV Managers Fund, LLC, a Delaware limited liability company ("Managers Fund") acquired, in the aggregate, 10,000 shares of Series C Non Convertible Preferred Stock ("Preferred Stock") of the Issuer in a directly negotiated transaction at an aggregate purchase price of $1,000,000. Fund III purchased 9,539 shares of Preferred Stock of the Issuer, Entrepreneur Fund purchased 354 shares of Preferred Stock of the Issuer and Managers Fund purchased 107 shares of Preferred Stock of the Issuer.
  • [F10]In connection with the Preferred Stock Purchase, on October 17, 2011, Fund III received an immediately exercisable 5-year warrant to purchase 257,544 shares of Issuer's Common Stock, Entrepreneur Fund received a warrant to purchase 9,568 shares of Issuer's Common Stock and Managers Fund received a warrant to purchase 2,888 shares of Issuer's Common Stock (collectively, the "Warrants"). Each warrant is exercisable at a price of $2.90 per share.
  • [F11]Represents Warrants owned directly by Fund III.
  • [F12]Represents Warrants owned directly by Entrepreneur Fund.
  • [F13]Represents Warrants owned directly by Managers Fund.
  • [F14]Represents warrants owned indirectly by the General Partner.
  • [F15]Represents warrants owned indirectly by Mr. Backus.
  • [F16]Represents warrants owned indirectly by Mr. Hixon.
  • [F17]Represents warrants owned indirectly by Mr. Johnson.
  • [F18]Represents warrants owned indirectly by Mr. Delistathis.
  • [F2]Represents shares owned directly by Fund III.
  • [F3]Represents shares owned directly by Entrepreneur Fund.
  • [F4]Represents shares owned directly by Managers Fund.
  • [F5]Represents shares of Preferred Stock held indirectly by New Atlantic Fund III, LLC (the "General Partner"), the General Partner of Fund III and Entrepreneur Fund.
  • [F6]Represents 9539 shares of Preferred Stock held indirectly by Mr. Backus in Fund III, 354 shares of Preferred Stock held indirectly by Mr. John Backus in Entrepreneur Fund, and 107 shares of Preferred Stock held indirectly by Mr. Backus in Managers Fund.
  • [F7]Represents 9539 shares of Preferred Stock held indirectly by Mr. Hixon in Fund III, 354 shares of Preferred Stock held indirectly by Mr. Todd Hixon in Entrepreneur Fund, and 107 shares of Preferred Stock held indirectly by Mr. Hixon in Managers Fund.
  • [F8]Represents 9539 shares of Preferred Stock held indirectly by Mr. Johnson in Fund III, and 354 shares of Preferred Stock held indirectly by Mr. Scott Johnson in Entrepreneur Fund.
  • [F9]Represents 9539 shares of Preferred Stock held indirectly by Mr. Delistathis in Fund III, and 354 shares of Preferred Stock held indirectly by Mr. Thanasis Delistathis in Entrepreneur Fund.

Documents

1 file

Issuer

HealthWarehouse.com, Inc.

CIK 0000754813

→
Entity typeother

Related Parties

1
  • filerCIK 0001362651

Filing Metadata

Form type
4
Filed
Oct 25, 8:00 PM ET
Accepted
Oct 26, 6:59 PM ET
Size
40.8 KB
View on SEC.gov