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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially 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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Common Stock Purchase Warrant | $ 0.4 | 03/13/2013 | A | 1,250,000 | 03/13/2013 | 03/13/2016 | Common Stock, Par Value $0.001 | $ 1,250,000 | (2) | 1,250,000 | D | ||||
Common Stock Purchase Warrant | $ 0.8 | 12/03/2010 | 12/03/2013 | Common Stock, Par Value $0.001 | 83,334 | 83,334 | D | ||||||||
Common Stock Purchase Warrant | $ 0.8 | 04/06/2011 | 04/06/2014 | Common Stock, Par Value $0.001 | 125,000 | 125,000 | D | ||||||||
Common Stock Purchase Warrant | $ 0.25 | 01/31/2012 | 01/31/2015 | Common Stock, Par Value $0.001 | 150,000 | 150,000 | D | ||||||||
Common Stock Purchase Warrant | $ 0.25 | 05/11/2012 | 05/11/2015 | Common Stock, Par Value $0.001 | 50,000 | 50,000 | D | ||||||||
Common Stock Purchase Warrant | $ 0.25 | 08/03/2012 | 08/03/2015 | Common Stock, Par Value $0.001 | 100,000 | 100,000 | D | ||||||||
Common Stock Purchase Warrant | $ 0.4 | 02/21/2013 | 02/21/2016 | Common Stock, Par Value $0.001 | 250,000 | 250,000 | D | ||||||||
Common Stock Purchase Warrant | $ 0.8 | 12/03/2010 | 12/03/2013 | Common Stock, Par Value $0.001 | 83,334 | 83,334 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
BAKSA STEPHEN D 2 WOODS LANE CHATHAM, NJ 07928 |
X |
/s/ Stephen D. Baksa | 04/29/2013 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Shares held by the Stephen D. Baksa 2012 Trust F/B/O Sarah E. Marra, F/B/O Brian S. Baksa. |
(2) | On March 13, 2013, the Company entered into a subscription agreement with Mr. Baksa pursuant to which Mr. Baksa purchased 2,500,000 shares of the Company's common stock for a purchase price of $500,000, together with a common stock purchase warrant to acquire 1,250,000 shares of common stock at $0.40 per share for a period of three years. |