# EDGAR Filing Document

**Accession Number:** 0001302378
**File Stem:** 0001493152-23-005953
**Filing Date:** 2023-2
**Character Count:** 6849
**Document Hash:** 43af3fd204f9680be617770412b69b63
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001493152-23-005953.hdr.sgml**: 20230224

**ACCESSION NUMBER**: 0001493152-23-005953

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230224

**FILED AS OF DATE**: 20230224

**DATE AS OF CHANGE**: 20230224

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Lai John
- **CENTRAL INDEX KEY:** 0001302378

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40715
- **FILM NUMBER:** 23666053

**MAIL ADDRESS:**
- **STREET 1:** 12100 SINGLETREE LANE
- **STREET 2:** SUITE 186
- **CITY:** EDEN PRAIRIE
- **STATE:** MN
- **ZIP:** 55344
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** PetVivo Holdings, Inc.
- **CENTRAL INDEX KEY:** 0001512922
- **STANDARD INDUSTRIAL CLASSIFICATION:** SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
- **IRS NUMBER:** 990363559
- **STATE OF INCORPORATION:** NV
- **FISCAL YEAR END:** 0331

**BUSINESS ADDRESS:**
- **STREET 1:** 5251 EDINA INDUSTRIAL BLVD
- **CITY:** EDINA
- **STATE:** MN
- **ZIP:** 55439
- **BUSINESS PHONE:** (952) 217-4952

**MAIL ADDRESS:**
- **STREET 1:** 5251 EDINA INDUSTRIAL BLVD
- **CITY:** EDINA
- **STATE:** MN
- **ZIP:** 55439

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Technologies Scan Corp
- **DATE OF NAME CHANGE:** 20110211

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Lai John<br><sub>(Last) (First) (Middle)</sub><br>5251 EDINA INDUSTRIAL BLVD<br><sub>(Street)</sub><br>EDINA,, MN 55439<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-02-24 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_CEO and President_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>PetVivo Holdings, Inc. [ PETV ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2023-02-24 |  | A<sup>(1)</sup> |  | 60600 | A | <sup>(2)</sup> | 1138592<sup>(3)</sup> | D |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |

---

### Footnotes:

(1) This award ("Award") was granted under the PetVivo Holdings, Inc. Amended and Restated 2020 Equity Incentive Plan ("2020 Plan") in the form of restricted stock units ("RSU's) which will be settled in shares of the Company's common stock on a one-for-one basis. The Award vests in six equal installments, with 10,100 RSU's vesting on March 1, 2023 and 10,100 RSU's vesting on the first day of each month thereafter such that all RSU's will be fully-vested as of August 1, 2023, subject to Mr. Lai's continued employment with the Issuer through each applicable vesting date.

(2) Mr. Lai voluntarily agreed to accept this Award in lieu of receiving cash for his salary payments during the six month period beginning on March 1, 2023 and expiring on August 31, 2023 (the 'Interim Period"). The Compensation Committee calculated the total number of shares to be issued to Mr. Lai by taking (A) Mr. Lai's salary during the Interim Period ($175,000) divided by (B) the volume weighted average closing price of the Issuer's common stock during the 10 day period preceding February 22, 2023 ($2.8878), rounded up to the nearest whole share.

(3) Includes 160,600 shares that will be issued over time upon vesting and settlement of RSU's granted to Mr. Lai under the 2020 Plan.

**Signature:** /s/ John Lai  
**Date:** 2023-02-24

### Remarks:

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).

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.**