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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 Warrant | $ 0.05 | 12/23/2015 | A | 4,000,000 | 12/23/2015 | 12/31/2020(1) | Common Stock | 4,000,000 | (2) | 4,000,000 | I | LLC (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
OMAN MARK C 1588 BURR OAKS DR. WEST DES MOINES, IA 50266 |
X |
/s/ MARK C. OMAN | 12/28/2015 | |
**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 expiration date of the warrant is the earlier of (i) December 31, 2020 and (ii) the date that is forty-five (45) days following the date on which the daily closing price of the Issuer's shares of common stock listed on the OTCQB Venture Marketplace (or other bulletin board or exchange on which the Issuer's common stock is traded or listed) exceeds $0.25 for at least ten (10) consecutive trading days. |
(2) | On December 23, 2015, the Issuer and the holders of the 5% Secured Convertible Notes due December 2017 (formerly due March 2016) (the "Notes") entered into a Second Amended and Restated Note and Warrant Purchase Agreement (the "Agreement"), which (i) extended the maturity date of the Notes to December 31, 2017; (ii) provided for the issuance of certain warrants to prior and current investors; (iii) extended the time during which Notes may be issued; and (iv) increased the aggregate principal amount of Notes issuable. Pursuant to the Agreement, in consideration for extending the maturity date of the Notes, the Reporting Person received a warrant to purchase shares of the Issuer's common stock, exercisable at $0.05 per share, equal to the aggregate principal amount of Notes held by the Reporting Person prior to December 23, 2015. |
(3) | Warrant to purchase shares of common stock is held in the name of Oman Ventures, LLC of which Mr. Oman is the President. |