Sec Form 5 Filing - WITHROW EDWARD W III @ PARALLAX HEALTH SCIENCES, INC. - 2021-12-31

Insider filing report for Changes in Beneficial Ownership
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FORM 5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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
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1. Name and Address of Reporting Person
WITHROW EDWARD W III
2. Issuer Name and Ticker or Trading Symbol
PARALLAX HEALTH SCIENCES, INC. [ PRLX]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
3415 S SEPULVEDA BLVD, SUITE 1100-1234
3. Date of Earliest Transaction (MM/DD/YY)
12/31/2021
(Street)
LOS ANGELES, CA90034
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ 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. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
PREFERRED STOCK (SERIES A) 09/30/2011( 1 ) J( 1 ) V 36,339 A $ 2.75 399,732 I By Huntington Chase Financial Group
PREFERRED STOCK (SERIES A) 11/06/2021 J( 2 ) V 396,339 A $ 0 796,071 I By Huntington Chase Financial Group
PREFERRED STOCK (SERIES A) 11/06/2021 J( 3 ) V 796,071 D $ 0 0 I By Huntington Chase Financial Group
COMMON STOCK 11/06/2021 J( 3 ) V 15,921,420( 3 ) A $ 0 72,430,792 I By Huntington Chase LLC
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. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Benefi cially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
STOCK OPTION $ 0.25 03/31/2021 D V 3,000,000( 4 ) ( 4 ) 12/31/2022 COMMON STOCK 3,000,000 $ 0 1,000,000 I By Huntington Chase LLC
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
WITHROW EDWARD W III
3415 S SEPULVEDA BLVD
SUITE 1100-1234
LOS ANGELES, CA90034
X
Signatures
EDWARD W. WITHROW III 03/17/2022
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Additional Series A Preferred shares acquired; not included in previous Form 5 for the year 12/31/2012. Total Series A Preferred shares held at 12/31/12 = 399,732.
( 2 )Cumulative dividends in kind on Series A Preferred Stock.
( 3 )Conversion of preferred stock into common stock at a ratio of 20 shares of common stock for each share of preferred stock.
( 4 )Unvested stock options canceled upon resignation of Reporting Person.

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).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

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