SEC FORM 3 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*
Acuitas Group Holdings, LLC

(Last) (First) (Middle)
2120 COLORADO AVENUE, #230

(Street)
SANTA MONICA CA 90404

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
04/28/2017
3. Issuer Name and Ticker or Trading Symbol
Ontrak, Inc. [ OTRK ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 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)
Common Stock 3,701,665(1) D
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
Warrant to Purchase 08/15/2016 08/15/2021 Common Stock 498,927(2) $4.8(2) D
Warrant to Purchase 12/15/2016 12/15/2021 Common Stock 170,473(2) $4.8(2) D
Warrant to Purchase 01/31/2017 01/31/2022 Common Stock 196,707(2) $4.8(2) D
Warrant to Purchase 02/17/2017 02/17/2022 Common Stock 61,765(2) $4.8(2) D
Warrant to Purchase 03/06/2017 03/06/2022 Common Stock 49,020(2) $4.8(2) D
Warrant to Purchase 03/28/2017 03/28/2022 Common Stock 49,020(2) $4.8(2) D
Warrant to Purchase 04/13/2017 04/13/2022 Common Stock 36,275(2) $4.8(2) D
Warrant to Purchase 04/28/2017 07/30/2020 Common Stock 155,834(2) $1.8(2) D
Explanation of Responses:
1. Represents amounts held by the Reporting Person as of April 28, 2017. For the Reporting Person's beneficial ownership information of the issuer's common stock as of the date of this filing, please refer to the Form 4 jointly filed by Terren S. Peizer ("Mr. Peizer") and the Reporting Person on the date hereof. Mr. Peizer is the Chairman and sole member of the Reporting Person and, in such capacity, exercises voting and investment power over any securities held for the account of the Reporting Person.
2. After giving effect to a 1:6 reverse stock split conducted by the issuer in April 25, 2017.
ACUITAS GROUP HOLDINGS, LLC By: Terren S. Peizer, Chairman /s/ Terren S. Peizer 05/11/2021
** 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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