3/A [Amend] - Initial statement of beneficial ownership of securities

Document Info
Form Name: 3/A
Filed: April 12, 2019
 
SEC FORM 3/A SEC Form 3
FORM 3 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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Dey Michael

(Last) (First) (Middle)
2749 PARLEYS WAY
SUITE 100

(Street)
SALT LAKE CITY UT 84019

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/09/2019
3. Issuer Name and Ticker or Trading Symbol
PREDICTIVE TECHNOLOGY GROUP, INC. [ PRED ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
04/12/2019
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 Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Common Stock Options 08/01/2017(1) 08/01/2022 Common Stock 750,000 0.5 D
Common Stock Options 04/09/2019(2) 04/09/2029 Common Stock 750,000 2.07 D
Explanation of Responses:
1. Options exercisable for 450,000 shares will immediately vest on the date hereof. Options exercisable for 30,000 shares will vest on the thirty-day anniversary of the Grant Date for eleven months.
2. Options exercisable for 250,000 shares become exercisable on April 09, 2020, options exercisable for 250,000 shares become exercisable on April 09, 2021 and options exercisable for 250,000 shares become exercisable on April 09, 2022.
Remarks:
Mr. Michael Dey has filed this amendment to add option grant as of August 1, 2017 for a total of 750,000 shares at a price of $0.50. He has 1,500,000 total option grants from Predictive Technology Group, Inc. from both dates, August 1, 2017 and April 9, 2019.
/s/ Michael Dey 04/12/2019
** 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 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).
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 Number.