Amended Annual Statement of Changes in Beneficial Ownership (5/a)
31 Enero 2013 - 12:10PM
Edgar (US Regulatory)
FORM 5
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
[ ]
Form 3 Holdings Reported
[ ]
Form 4 Transactions Reported
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0362
Estimated average burden
hours per response...
1.0
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
MCMORRAN DOREEN
|
2. Issuer Name
and
Ticker or Trading Symbol
SKINVISIBLE INC [SKVI]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
|
(Last)
(First)
(Middle)
6320 S. SANDHILL RD UNIT 10
|
3. Statement for Issuer's Fiscal Year Ended
(MM/DD/YYYY)
12/31/2011
|
(Street)
LAS VEGAS, NV 89120
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
2/21/2012
|
6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
|
1.Title of Security
(Instr. 3)
|
2. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. Code
(Instr. 8)
|
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
|
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
|
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
|
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
|
Amount
|
(A) or (D)
|
Price
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security
(Instr. 3)
|
2. Conversion or Exercise Price of Derivative Security
|
3. Trans. Date
|
3A. Deemed Execution Date, if any
|
4. Trans. Code
(Instr. 8)
|
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
|
6. Date Exercisable and Expiration Date
(MM/DD/YYYY)
|
7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
|
8. Price of Derivative Security
(Instr. 5)
|
9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4)
|
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
|
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
|
(A)
|
(D)
|
Date Exercisable
|
Expiration Date
|
Title
|
Amount or Number of Shares
|
Debt Conversion Rights
|
$0.04
|
12/31/2011
|
|
C
(1)
|
868775
|
|
12/31/2011
|
12/31/2016
(2)
|
Common Stock
|
868775
|
$0
(1)
|
28851909
|
D
|
|
Debt Conversion Rights (Warrants)
|
$0.06
|
12/31/2011
|
|
C
(1)
|
434388
|
|
12/31/2011
|
12/31/2019
(1)
(2)
|
Common Stock
|
434388
|
$0
(1)
|
29286297
|
D
|
|
Explanation of Responses:
|
(
1)
|
On December 31, 2011 the Issuer issued a Promissory Note due to Ms. McMorran totaling $34,751. Under the terms of the Promissory Note, Ms. McMorran has the right to convert all or any part of the principal sum of the loan into common stock of the Issuer as well as a warrant agreement to purchase one share for every two shares acquired. The expiration date on the warrant is 3 years from the date of conversion.
|
(
2)
|
The expiration date previously reported was erroneously stated and has been corrected.
|
Reporting Owners
|
Reporting Owner Name / Address
|
Relationships
|
Director
|
10% Owner
|
Officer
|
Other
|
MCMORRAN DOREEN
6320 S. SANDHILL RD UNIT 10
LAS VEGAS, NV 89120
|
|
X
|
|
|
Signatures
|
/s/ Doreen McMorran
|
|
1/30/2013
|
**
Signature of Reporting Person
|
Date
|
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
|
*
|
If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
|
**
|
Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
|
Note:
|
File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
|
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
|
Skinvisible (QB) (USOTC:SKVI)
Gráfica de Acción Histórica
De May 2024 a Jun 2024
Skinvisible (QB) (USOTC:SKVI)
Gráfica de Acción Histórica
De Jun 2023 a Jun 2024
Real-Time news about Skinvisible Inc (QB) (OTCMarkets): 0 recent articles
Más de Skinvisible Inc Artículos de Noticias