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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 | ||||||||
Series B Convertible Preferred Stock (1) (2) | $ 0.02 | 02/11/2011 | P | 40,000 | (1) | (1) | Common Stock | 2,000,000 | (2) | 40,000 | D | ||||
Common Stock Warrants (Right to Buy) (2) | $ 0.06 | 02/11/2011 | P | 1,000,000 | 02/11/2011 | 02/11/2014 | Common Stock | 1,000,000 | (2) | 1,000,000 | D | ||||
Common Stock Warrants (Right to Buy) (3) | $ 0.06 | 03/28/2011 | M | 1,000,000 | 02/11/2011 | 02/11/2014 | Common Stock | 1,000,000 | (3) | 0 | D | ||||
Series C Convertible Preferred Stock (4) | (3) | 03/28/2011 | A | 10,000 | (4) | (4) | Common Stock | 1,000,000 | (3) | 10,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Frohman Scott 123 NW 13TH STREET STE 300 BOCA RATON, FL 33432 |
X |
/s/ Scott Frohman | 03/30/2011 | |
**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) | These securities are convertible into the issuer's common stock at any time after the issuer increases its authorized capital. At such time, each share of the Series B Preferred Stock will be convertible into 50 shares of the issuer's common stock. The securities have no expiration date. |
(2) | The securities are included within one Unit purchased by the reporting person for $100,000 per Unit. Each Unit consists of 100,000 shares of Series B Convertible Preferred Stock and 2,500,000 warrants to purchase shares of common stock. The reporting person purchased 0.4 Units. |
(3) | The reporting person exercised the warrants at a reduced price of $0.015 per share of Series C Preferred Stock. |
(4) | The securities automatically convert into the issuer's common stock after the issuer increases its authorized capital. At such time, each share of Series C Preferred Stock will be convertible into 100 shares of the issuer's common stock. The securities have no expiration date. |