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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 | ||||||||
6% Senior Subordinated Convertible Note | $ 0.23 (1) | 01/27/2014 | P(1) | 1 (1) | 01/27/2014 | 01/26/2017 | Common Stock | 217,392 | (1) | 1 (1) | I (1) | By Ratiner Family 2005 Revocable Living Trust | |||
Common Stock Purchase Warrant | $ 0.23 | 01/27/2014 | P(1) | 1 (1) | 01/27/2014 | 01/26/2024 | Common Stock | 108,696 | (1) | 1 (1) | I (1) | By Ratiner Family 2005 Revocable Living Trust |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Ratiner Boris 18375 VENTURA BOULEVARD, #552 TARZANA, CA 91356 |
X |
/s/ Boris Ratiner | 01/28/2014 | |
**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) | The Ratiner Family 2005 Revocable Living Trust purchased the note and warrant for aggregate consideration of $50,000 from the Registrant. The note has a conversion price equal to the lesser of $0.23 and 70% of the average of the three (3) lowest daily volume weighted average prices occurring during the 20 consecutive trading days immediately preceding the applicable conversion date. Conversion of the note and exercise of the warrant are subject to a beneficial ownership cap of 4.99%. The reporting person, the trustee of Ratiner Family 2005 Revocable Living Trust, exercises voting and dispositive power over the shares held by the trust but disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein. |