UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
5% Secured Convertible Notes due December 2017 (1) | (1) | 12/31/2017(1) | Common Stock | 22,000,000 (1) | $ 0.05 (2) | D | |
Common Stock Warrant | 12/23/2015 | 12/31/2020(3) | Common Stock | 22,000,000 | $ 0.05 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
RSJ Private Equity Investment Fund with variable registered capital, a.s. 26522 LA ALAMEDA, SUITE 290 C/O MYND ANALYTICS, INC. MISSION VIEJO, CA 92691 |
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/s/ Jan Vyhnalek, as statutory director/CEO of RSJ Private Equity investicni fond s promennym zakladnim kapitalem, A.S. | 09/15/2016 | |
**Signature of Reporting Person | Date |
* | 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) | As of December 23, 2015, the Reporting Person holds $1,100,000 in secured 5% convertible promissory notes (the "Notes"), which mature on December 31, 2017 (subject to earlier conversion or prepayment) and earn interest at a rate of 5% per annum with interest payable at maturity. The Notes are convertible into shares of common stock, par value $0.001 per share (the "Common Stock"), of MYnd Analytics, Inc. (the "Issuer") (i) automatically upon the closing of a qualified equity offering with total proceeds of at least $5 million, at a conversion price of $0.05 per share, or (ii) voluntarily, within 15 days prior to maturity, at a conversion price of $0.05 per share. |
(2) | The conversion rate for the Notes is $0.05 per share of Common Stock. |
(3) | The expiration date of the warrants to purchase shares of Common Stock is the earlier of (i) December 31, 2020 and (ii) the date that is 45 days following the date on which the daily closing price of the Issuer's shares of Common Stock listed on the OTCQB Venture Marketplace (or other bulletin board or exchange on which the Issuer's Common Stock is traded or listed) exceeds $0.25 for at least ten consecutive trading days. |