Insider filing report for Changes in Beneficial Ownership
- Schedule 13G & 13D forms are used to report a party's ownership of stock which exceeds 5% of a company's total stock issue.
- Schedule 13G is a shorter version of Schedule 13D with fewer reporting requirements.
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13D
Under the Securities Exchange Act of 1934
(Amendment No. 3)*
Rennova Health, Inc.
(Name of Issuer)
Common Stock, $.01 par value
(Title of Class of Securities)
759757 10 7
(CUSIP Number)
Thomas Francis Mendolia DO
400 South Australian Avenue, 8th Floor
West Palm Beach, FL 33401
(561) 855-1626
(Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications)
September 21, 2016
(Date of Event which Requires Filing of This Statement)
If the filing person has previously filed a statement on Schedule 13G to report the acquisition which is the subject of this Schedule 13D, and is filing this schedule because of §§ 240.13d-1(e), 240.13d-1(f) or 240.13d-1(g), check the following box ☐.
Note: Schedules filed in paper format shall include a signed original and five copies of the schedule, including all exhibits. See §240.13d-7 for other parties to whom copies are to be sent.
*The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter disclosure provided in a prior cover page.
The information required on the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
| CUSIP No. 759757 10 7 | Page 2 of 4 |
| 1. |
Names of Reporting Persons Thomas Francis Mendolia DO | |||
| 2. |
Check the Appropriate Box if a Member of a Group (a) ☐ (b) ☐ | |||
| 3. | SEC Use Only | |||
| 4. |
Source of Funds (See Instructions) OO | |||
| 5. | Check Box if Disclosure of Legal Proceedings is Required Pursuant to Items 2(d) or 2(e) ☐ | |||
| 6. |
Citizenship or Place of Organization United States | |||
|
Number Of With |
7. |
Sole Voting Power 6,517,246 |
||
| 8. |
Shared Voting Power -0- |
|||
| 9. |
Sole Dispositive Power 6,517,246 |
|||
| 10. |
Shared Dispositive Power -0- |
|||
| 11. |
Aggregate Amount Beneficially Owned by Each Reporting Person 6,517,246 | |||
| 12. | Check Box if the Aggregate Amount in Row (11) Excludes Certain Shares (See Instructions) ☐ | |||
| 13. |
Percent of Class Represented by Amount in Row (11) 11.2% | |||
| 14. |
Type of Reporting Person IN | |||
| CUSIP No. 759757 10 7 | Page 3 of 4 |
Item 1. Security and Issuer
This Amendment No. 3 to Schedule 13D amends the Statem ent on Schedule 13D, dated November 2, 2015, as previously amended by Amendments No. 1 and No. 2 to Schedule 13D, with respect to the Common Stock, $0.01 par value per share (the "Shares"), of Rennova Health, Inc., a Delaware corporation (the "Issuer"), filed by Thomas Francis Mendolia DO. Except as expressly amended below, the Schedule 13D, dated November 2, 2015, as previously amended, remains in effect.
Item 3. Source and Amount of Funds or Other Consideration
Item 3 is hereby amended to include the following:
This Amendment No. 3 to Schedule 13D is being filed to report the conversion by Dr. Mendolia of 1,000 shares of the Issuer's Series B Convertible Preferred Stock on September 21, 2016, into 1,146,789 Shares.
Item 5. Interest in Securities of the Issuer
Item 5 is hereby amended to include the following:
As of September 21, 2016, Dr. Mendolia may be deemed to beneficially own 6,517,246 Shares (or approximately 11.2% of the total number of Shares deemed outstanding), which consists of (i) 3,739,847 Shares, (ii) 2,040,000 stock options owned of record by Dr. Mendolia to purchase a like number of Shares, and (iii) 737,399 warrants owned of record by Dr. Mendolia to purchase a like number of Shares; all as to which Dr. Mendolia has sole dispositive and voting power.
| CUSIP No. 759757 10 7 | Page 4 of 4 |
SIGNATURES
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
| October 10, 2016 |
/s/ Thomas Francis Mendolia DO Thomas Francis Mendolia DO
|