SOURCE: VERTICAL HEALTH SOLUTIONS INC
10/4/2012 4:21:00 PM

VERTICAL HEALTH SOLUTIONS INC - 4

 

FORM 4

 

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C.  20549

 

OMB APPROVAL

 

 

 

?              Check this box if no longer subject to Section 16.  Form 4 or Form 5 obligations may continue. 
See Instruction 1(b).

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES

 

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility

Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940

 

OMB Number:  3235-0287

Expires:  February 28, 2011

Estimated average burden

hours per response…...0.5

(Print or Type Responses)

 

 

1.              Name and Address of Reporting Person*

 

2.              Issuer Name and Ticker or Trading Symbol

5.              Relationship of Reporting Person(s) to Issuer
 

 

Vertical Health Solutions, Inc. (ONMD)

              (Check all applicable)

Chafoulias                    Gus            

 

 

X

Director

 

 

10% Owner

(Last)              (First)                            (Middle)

3.               Date of Earliest Transaction (Month/Day/Year)

 

 

Officer (give

 

 

Other (specify

c/o Vertical Health Solutions, Inc.

 

 

 

title below)

 

 

below)

7760 France Avenue South, 11th Floor

09/28/2012

 

 

 

 

(Street)

4.              If Amendment, Date Original Filed (Month/Day/Year)

6.               Individual or Joint/Group Filing   (Check applicable line)

 

 

 

X

Form filed by One Reporting Person

Minneapolis                MN               55435

 

 

 

Form filed by More than One Reporting Person

(City)              (State)                            (Zip)

 

 

 

 

Table I – Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

1.              Title of Security
(Instr. 3)

2. Trans-  action Date

2A.Deemed Execut- ion Date, if any

3. Transac-tion Code (Instr. 8)

4.              Securities Acquired (A) or Disposed of (D)

              (Instr. 3, 4 and 5)

5.              Amount of
Securities Beneficially
Owned Following

6. Ownership Form: Direct
(D) or 

 

7.              Nature of Indirect Beneficial Ownership

             

 

(Month/
   Day/
   Year)

  (Month/
   Day/
   Year)

 

 

Code

 

 

V

 

 

Amount

(A)or (D)

 

 

Price

Reported
Transaction(s)

(Instr. 3 and 4)

Indirect (I)

 

(Instr. 4)

 

 

(Instr. 4)

Common Stock

09/28/12

 

J(1)

 

111,219

A

$0.25

981,219

D

 

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).

Potential persons who are to respond to the collection of information
contained in this form not required to respond unless the form displays a

(Over)
SEC 1474 (9-02)

 

currently valid OMB control number.

 


 

FORM 4 (continued)

Table II – Derivative Securities Acquired, Disposed of, or Beneficially Owned

(e.g., puts, calls, warrants, options, convertible securities)

1.              Title of Derivative Security
(Instr. 3)

2. Conver-sion or Exercise Price of Deriva-tive Security

3.              Trans-action Date (Month/ Day/
Year)

3A.Deemed
  Execu-
  tion 
  Date,
  if any 
  (Month/
   Day/
   Year)

4. Trans- action 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 (Month/Day/ Year)

 

7.               Title and Amount of Underlying Securities

(Instr. 3 and 4)

 

8. Price
of
Deriv-ative Secu-rity
(Instr. 5)

9.              Number
of Deriva-
tive Securi
ties Bene-
ficially Owned
Following Reported

10.Owner-
ship Form
of Deriv-
ative Security:
Direct
(D) or Indirect

11. Nature   of Indirect Benefi-cial Owner-ship
(Instr.  4)

 

 

 

 

Code

V

(A)

(D)

Date
Exercisable

Expira-
tion
Date

Title

Amount
or Number
of  Shares

 

              Transac-
tion(s)

  (Instr. 4)

  (I)

  (Instr. 4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explanation of Responses:

(1)              On September 28, 2012, the company and the reporting person agreed to amend $25,000 of 15% promissory notes held by the reporting person to permit conversion of the principal and interest outstanding under the notes into shares of the company’s common stock at a fixed conversion price of $0.25 per share.  Concurrently with the amendment, the reporting person agreed to convert the balance of principal and interest underlying the notes.

 

 

**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. 

/s/ William Cavanaugh (attorney-in-fact)

 

10/04/12

If space is insufficient, see Instruction 6 for procedure.

**Signature of Reporting Person

 

Date

 

 

 

 

Potential persons who are to respond to the collection of information contained in this form

 

 

 

not required to respond unless the form displays a currently valid OMB control number.