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FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL
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(Print or Type Responses)
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1. Name and Address of Reporting Person *
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Peters Joseph B |
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2. Date of Event Requiring Statement (Month/Day/Year)
04/20/2017 |
3. Issuer Name and Ticker or Trading Symbol
HealthWarehouse.com, Inc. [HEWA]
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7107 INDUSTRIAL ROAD |
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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_____ Director
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_____ 10% Owner
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__X__ Officer (give title below)
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_____ Other (specify below)
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Interim President and CEO
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5. If Amendment, Date Original Filed
(Month/Day/Year)
04/11/2017 |
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FLORENCE, KY 41042 |
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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| Common Shares | 0 |
D
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| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) |
| 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. | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(Month/Day/Year)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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| Common Shares |
(1) | 04/03/2025 | Common Shares | 100,000 |
$0.09 | D |
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| Common Shares |
(2) | 08/05/2025 | Common Shares | 100,000 |
$0.11 | D |
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| Common Shares |
(2) | 11/09/2026 | Common Shares | 1,000 |
$0.35 | D |
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| Common Shares |
(2) | 12/23/2023 | Common Shares | 40,000 |
$0.53 | D |
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| Common Shares |
(2) | 02/15/2023 | Common Shares | 7,000 |
$1.6 | D |
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| Common Shares |
(2) | 10/15/2022 | Common Shares | 3,000 |
$4.95 | D |
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| Common Shares |
(2) | 03/30/2022 | Common Shares | 15,000 |
$6.99 | D |
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Reporting Owners
| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Peters Joseph B
7107 INDUSTRIAL ROAD
FLORENCE, KY 41042 |
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Interim President and CEO |
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Signatures
| /s/ F. Mark Reuter, as Attorney-in-Fact for Joseph Peters | | 04/20/2017 |
| **Signature of Reporting Person | Date |
Explanation of Responses:
| * | If the form is filed by more than one reporting person, see Instruction 5(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). |
| (1) | The option vests one-third on 4/3/16, one-third on 4/3/17, and one-third on 12/4/17. |
| (2) | The options vest one-third on the first anniversary of the grant date, one-third on the second anniversary of the grant date, and one third on the third anniversary of the grant date. |
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.
Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB number.
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