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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, Section 17(a) of the Public Utility Holding Company Act of 1935 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 | ||||||||
10% Secured Convertible Promissory Note Due 2015 (1) | $ 0.1 | 07/31/2012 | D | $ 25,000 | 01/18/2012 | 01/18/2015 | Common Stock | 250,000 | $ 0 | $ 0 | D | ||||
10% Secured Convertible Promissory Note Due 2015 (1) (3) | $ 0.07 | 07/31/2012 | A | $ 25,000 | 01/18/2012 | 07/31/2015 | Common Stock | 357,143 | $ 0 | $ 25,000 | D | ||||
Common Stock Warrant, right to buy (2) | $ 0.12 | 07/31/2012 | D | 250,000 | 01/18/2012 | 01/18/2017 | Common Stock | 250,000 | $ 0 | 0 | D | ||||
Common Stock Warrant, right to buy (2) (3) | $ 0.08 | 07/31/2012 | A | 428,571 | 01/18/2012 | 07/31/2017 | Common Stock | 428,571 | $ 0 | 428,571 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SHORT W. JOHN 6720 N SCOTTSDALE RD STE 390 SCOTTSDALE, AZ 85253 |
X | Chief Executive Officer |
J. Dale Belt, by power of attorney | 08/06/2012 | |
**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) | On 7/31/12, the promissory note issued under the Note and Warrant Purchase Agreement dated 1/17/12 was amended to decrease the conversion price from $0.10 per share to $0.07 per share and the maturity date of the promissory note changed from 1/18/15 to 7/31/15. |
(2) | On 7/31/12, the warrant issued under the Note and Warrant Purchase Agreement dated 1/17/12 was amended to (i) decrease the exercise price from $0.12 per share to $0.08 per share, (ii) amend the expiration date of the warrantfrom 1/18/17 to 7/31/17, and (iii) increase the number of shares underlying the warrant to 428,571 shares. |
(3) | Contains full rachet antidilution provisions. |