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 of Derivative Security: 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 |
|
Stock Purchase Warrant
(1)
(2)
(3)
|
06/12/2009 |
06/30/2016 |
Common Stock, par value $.001
|
2,333,333
|
$
0.3
|
D
|
|
| * |
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). |
| (1) |
Does not include Common Stock Warrants to purchase an aggregate of 1,000,000 shares of Common Stock gifted for no
consideration at the time of issuance to certain relatives of Mr. Pappajohn for which he disclaims beneficial ownership. |
| (2) |
On June 12, 2009, the Issuer also issued to Mr. Pappajohn a Secured Convertible Promissory Note in the principal amount of
$1,000,000. In the event the Issuer consummates an equity financing transaction of at least $1,500,000 (excluding any and
all notes and other liabilities or indebtedness which are converted) during the term of such note, the then outstanding
principal amount of such note shall be automatically converted into the securities issued in the equity financing by
dividing such amount by the per share price paid by the investors in such financing. |
| (3) |
This Amendment to Form 3 is being filed to correct the reported number of shares of Common Stock underlying the Stock
Purchase Warrant acquired by Mr. Pappajohn on June 12, 2009, in light of the gift described in Note 1 above. The number of
shares underlying such warrant was previously reported as 3,333,333. |