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Filed by the Registrant
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☒
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Filed by a Party other than the Registrant
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☐
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☐
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Preliminary Proxy Statement
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☐
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Confidential, For Use of the Commission Only (as permitted by Rule 14a-6(e)(2))
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☒
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Definitive Proxy Statement
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☐
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Definitive Additional Materials
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☐
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Soliciting Material Pursuant to §240.14a-12
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Spine Injury Solutions, Inc.
(formerly Spine Pain Management, Inc.)
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(Name of Registrant as Specified In Its Charter)
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(Name of Person(s) Filing Proxy Statement, if other than the Registrant)
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☒
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No fee required.
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☐
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Fee computed on table below per Exchange Act Rules 14a-6(i)(1) and 0-11.
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(1)
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Title of each class of securities to which transaction applies:
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(2)
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Aggregate number of securities to which transaction applies:
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(3)
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Per unit price or other underlying value of transaction computed pursuant to Exchange Act Rule 0-11 (set forth the amount on which the filing fee is calculated and state how it was determined):
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(4)
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Proposed maximum aggregate value of transaction:
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(5)
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Total fee paid:
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☐
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Fee paid previously with preliminary materials.
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☐
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Check box if any part of the fee is offset as provided by Exchange Act Rule 0-11(a)(2) and identify the filing for which the offsetting fee was paid previously. Identify the previous filing by registration statement number, or the Form or Schedule and the date of its filing.
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(1)
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Amount previously paid:
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(2)
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Form, Schedule or Registration Statement No.:
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(3)
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Filing Party:
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(4)
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Date Filed:
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(1)
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To elect five directors;
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(2)
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To ratify the selection of Ham, Langston & Brezina, LLP as our independent registered public accounting firm for the fiscal year ending December 31, 2016; and
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(3)
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To transact such other business as may properly come before the meeting.
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By Order of the Board of Directors,
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October 13, 2016
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William F. Donovan, M.D.
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Chief Executive Officer and Chairman of the Board
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Important Notice Regarding the Availability of Proxy Materials for the Annual Meeting of Stockholders to be held November 29, 2016.
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The Proxy Statement, form of proxy card and Annual Report are available at:
www.spineinjurysolutions.com
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Name
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Age
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Position(s) and Office(s)
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William F. Donovan, M.D.
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73
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Chief Executive Officer, President and Director (Chairman)
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John Bergeron
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59
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Chief Financial Officer and Director
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(1)
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Each director should be an individual of the highest character and integrity;
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(2)
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Each director should have substantial experience that is of particular relevance to us;
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(3)
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Each director should have sufficient time available to devote to the affairs of the company; and
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(4)
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Each director should represent the best interests of the stockholders as a whole.
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(1)
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Medical, technical, scientific, academic, financial and other expertise, skills, knowledge and achievements useful to the oversight of our business;
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(2)
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Diversity of viewpoints, backgrounds, experiences and other demographics; and
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(3)
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The extent to which the interplay of the candidate’s expertise, skills, knowledge and experience with that of other Board members will build a Board that is effective, collegial and responsive to the needs of the company.
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Name and
Principal
Position
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Salary
($)
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Bonus
($)
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Stock
Awards ($)
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Option
Awards
($)
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Non-Equity
Incentive
Plan
Compensation
($)
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Change
in
Pension
Value
and
Nonqualified
Deferred
Compensation
($)
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All
Other
Compensation
($)
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Total
($)
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William Donovan, M.D.
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2015
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$
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120,000
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$
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-
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$
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-
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$
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-
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$
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-
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$
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-
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$
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-
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$
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120,000
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CEO and President
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2014
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102,461
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-
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-
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62,110
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(1)
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-
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-
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-
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164,571
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John Bergeron
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2015
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110,000
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-
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-
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-
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-
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110,000
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CFO
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2014
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88,988
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8,509
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44,000
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(2)
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-
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132,988
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(1)
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On June 6, 2011, we granted Dr. Donovan stock options to purchase 600,000 shares of common stock at an exercise price of $0.77 per share. We granted the options as consideration for his employment as Chief Executive Officer and President. The options vest and become exercisable in twelve quarterly periods for the first three years of the five-year life of the options. The fair value of the options was $432,000, of which $62,110 and $144,000 in compensation expense was recognized in the Statement of Operations for the years ended December 31, 2014 and December 31, 2013, respectively.
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(2)
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On November 30, 2012 we granted to Mr. Bergeron 200,000 unvested stock options to purchase shares of common stock at an exercise price of $0.54 per share. The stock options will expire on December 1, 2017, and 50,000 of the stock options will vest and become exercisable every six months during the term of the agreement. If at any time during the term of the agreement Mr. Bergeron’s employment with us should end, all unvested stock options will be relinquished. The fair market value of the options was $95,833, of which $44,000 and $48,000 in compensation expense was recognized in the Statement of Operations for the years ended December 31, 2014 and December 31, 2013, respectively.
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Option Awards
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Name
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Number of
Securities
Underlying
Unexercised
Options
(#)
Exercisable
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Number of
Securities
Underlying
Unexercised
Options
(#)
Unexercisable
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Equity
Incentive
Plan Awards: Number of
Securities
Underlying
Unexercised
Unearned
Options
(#)
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Option
Exercise
Price
($)
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Option
Expiration
Date
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William F. Donovan, M.D.
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550,000
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(1) |
-
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-
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0.77
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06/06/2016
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John R. Bergeron
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200,000
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(2) |
-
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-
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0.54
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12/01/2017
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(1)
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On June 6, 2011, we granted Dr. Donovan stock options to purchase 600,000 shares of common stock at an exercise price of $0.77 per share. We granted the options as consideration for his employment as Chief Executive Officer and President. The options vested and became exercisable in twelve quarterly periods for the first three years of the five-year life of the options. Dr. Donovan exercised 50,000 of the options on September 9, 2012.
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(2)
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On November 30, 2012, we granted Mr. Bergeron stock options to purchase 200,000 shares of common stock at an exercise price of $0.54 per share. We granted the options as consideration for his employment as Chief Financial Officer. The options vested and became exercisable in four six month periods for the first two years of the five-year life of the options.
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Name
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Fees Earned or Paid in Cash
($)
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Stock Awards
($)
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Option Awards
($)
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Non-Equity Incentive Plan Compensation
($)
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Nonqualified Deferred Compensation Earnings
($)
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All Other Compensation
($)
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Total
($)
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John Bergeron
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-
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-
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-
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-
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-
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0
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Jerry Bratton
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-
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-
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-
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-
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-
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-
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-
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William Donovan, M.D.
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-
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-
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-
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-
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-
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-
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-
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Jeffrey Cronk, D.C.
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-
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$
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12,000
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(1)
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-
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-
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-
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-
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$
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12,000
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Peter Dalrymple
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-
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-
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-
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-
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-
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-
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-
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Name and Address of Beneficial Owner
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Number of Common Shares
Beneficially Owned
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Percent of Class
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William F. Donovan, M.D. (1)
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4,382,427
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(2
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)
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21.19
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%
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Jeffrey Cronk, D.C. (1)
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25,000
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0.12
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%
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John Bergeron (1)
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360,000
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(3
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1.77
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%
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Jerry Bratton (1)
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1,556,100
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(4
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7.73
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%
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Peter L. Dalrymple (1)
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3,320,609
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(5
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16.22
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%
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All Directors and named executive officers as a group (5 persons)
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9,644,136
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45.45
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%
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(1)
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The named individual is one of our executive officers or directors. His address is c/o Spine Injury Solutions, Inc., 5225 Katy Freeway, Suite 600, Houston, Texas 77007.
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(2)
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Includes 557,486 shares of common stock held indirectly through NorthShore Orthopedics, Assoc. (of which Dr. Donovan is the sole shareholder and has voting and investment authority) and 3,274,941 shares held directly by Dr. Donovan. Also includes 550,000 shares of common stock issuable upon exercise of options that are fully vested and exercisable.
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(3)
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Includes 160,000 shares of common stock and 200,000 shares of common stock issuable upon exercise of options that are fully vested and exercisable.
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(4)
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Includes 1,556,100 shares of common stock held by Mr. Bratton, of which Mr. Bratton has sole voting and investment authority of 320,000 shares and shared voting and investment authority with his spouse of 1,236,100 shares.
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(5)
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Includes (a) securities held individually by Peter L. Dalrymple, including (i) 1,000,000 shares of common stock, and (ii) warrants that are exercisable into 333,333 shares of common stock; and (b) 1,987,276 shares of common stock held by LPD Investments Ltd. (“LPD”). Mr. Dalrymple is General Partner
of LPD and has voting and investment authority over shares held by it. He is also a Limited Partner of LPD with the other Limited Partners being his wife and three trusts, of which he is trustee and his children are beneficiaries.
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Plan Category
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(a)
Common
Shares to be
Issued Upon
Exercise of
Outstanding Options,
Warrants and Rights
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(b)
Weighted-average
Exercise
Price of
Outstanding Options,
Warrants and
Rights ($)
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(c)
Common
Shares
Available
for Future
Issuance Under
Equity Compensation
Plans (Excluding
Securities
Reflected in
Column (a))
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|||||||||
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Equity compensation plans approved by our stockholders
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--
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--
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--
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Equity compensation plans not approved by our stockholders (1)
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550,000
50,000
550,000
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0.77
0.50
0.54
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--
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|||||||||
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Total
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1,150,000
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0.65
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--
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(1)
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Consists of common shares to be issued upon exercise of outstanding stock options as follows:
·
In June 2011, we granted our CEO stock options to purchase a total of 600,000 shares of common stock at an exercise price of $0.77 per share. The options vest and become exercisable in twelve quarterly periods for the first three years of the five-year life of the options. A total of 550,000 of these options remain outstanding and unexercised.
·
In November 2015, we granted one of our consultants stock options to purchase a total of 50,000 shares of common stock at an exercise price of $.50 per share. The one-year options vested and became exercisable immediately.
·
In November 2012, we granted three of our employees stock options to purchase 600,000 shares of common stock at an exercise price of $.54 per share. The five year options vest every six months at 50,000 options per period. One employee left the company and lost his 50,000 of his options which did not vest.
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2015
|
2014
|
||||||
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Audit Fees (1)
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$
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64,000
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$
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56,210
|
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Audit Related Fees (2)
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-
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-
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||||||
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Tax Fees (3)
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-
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-
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||||||
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All Other Fees
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-
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-
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||||||
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Total Fees
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$
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64,000
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$
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56,210
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||||
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(1)
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Audit Fees: This category represents the aggregate fees billed for professional services rendered by the principal independent accountant for the audit of our annual financial statements and review of financial statements included in our Form 10-Q and services that are normally provided by the accountant in connection with statutory and regulatory filings or engagements for the fiscal years.
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(2)
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Audit Related Fees: This category consists of the aggregate fees billed for assurance and related services by the principal independent accountant that are reasonably related to the performance of the audit or review of our financial statements and are not reported under “Audit Fees.”
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(3)
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Tax Fees: This category consists of the aggregate fees billed for professional services rendered by the principal independent accountant for tax compliance, tax advice, and tax planning.
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By Order of the Board of Directors,
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William F. Donovan, M.D.
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Dated: October 13, 2016
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President, Chief Executive Officer and Director
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☐ FOR all nominees listed
below except as marked
to the contrary.
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☐ WITHHOLD authority to
vote for all nominees
below.
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NUMBER OF
SHARES OWNED
_______________
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SIGNATURE:__________________________________________
PRINTED NAME:_______________________________________
DATE: _______________________________________________
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Important Notice Regarding the Availability of Proxy Materials for the Annual Meeting of Stockholders to be held November 29, 2016.
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The Proxy Statement, form of proxy card and Annual Report are available at:
www.spineinjurysolutions.com
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No information found
* THE VALUE IS THE MARKET VALUE AS OF THE LAST DAY OF THE QUARTER FOR WHICH THE 13F WAS FILED.
| FUND | NUMBER OF SHARES | VALUE ($) | PUT OR CALL |
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| DIRECTORS | AGE | BIO | OTHER DIRECTOR MEMBERSHIPS |
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No information found
No Customers Found
No Suppliers Found
Price
Yield
| Owner | Position | Direct Shares | Indirect Shares |
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