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
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1. Name and Address of Reporting Person*
Dab Gerard

(Last) (First) (Middle)
400 S. AUSTRALIAN AVE.,
SUITE 800

(Street)
WEST PALM BEACH, FL 33401

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/27/2022
3. Issuer Name and Ticker or Trading Symbol
InnovaQor, Inc. [ INQR ]
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)
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
Explanation of Responses:
Remarks:
Gerard Dab owns 200 shares of Series C-1 Convertible Redeemable Preferred Stock (the "Series C-1 Preferred Stock") of InnovaQor, Inc. The Series C-1 Preferred Stock has a stated value of $1,000 per share and is convertible into the number of shares of Common Stock determined by dividing the stated value of the shares being converted by the conversion price, which equals 90% of the average closing price of the Common Stock on the 10 trading days immediately prior to the conversion date. If the conversion date were September 26, 2022, the 200 shares of Series C-1 Preferred Stock would have been convertible into 11,724,168 shares of Common Stock, due to the 4.99% ownership blocker in the terms of the Series C-1 Preferred Stock. If there were no ownership blocker, the 200 shares of Series C-1 Preferred Stock would have been convertible into 36,133,694 shares of Common Stock as of September 26, 2022. Because the conversion price of the Series C-1 Preferred Stock is determined based on the market price of the Common Stock, the number of shares of Common Stock into which the Series C-1 Preferred Stock is convertible will fluctuate.
No securities are beneficially owned.
/s/ Gerard Dab 02/21/2023
** 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.
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