UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Preferred Stock - 624,941 shares | 01/21/2010 | Â (5) | Common Stock | 624,941,000 | $ (2) | I | VIA Limited Liability Company (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SMITH C LEO 824 S.E. 8TH STREET FT. LAUDERDALE, FL 33316 |
 X |  X |  Chief Executive Officer |  |
/s/ C. LEO SMITH | 01/21/2010 | |
**Signature of Reporting Person | Date |
* | 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) | Common Stock issuable upon conversion of Series A Preferred Stock (See Table II below) |
(2) | No conversion price is payable for conversion of the Series A Preferred Stock into Common Shares. |
(3) | The Reporting Person is the sole member of IMS. IMS is the record owner of the shares being reported herein. |
(4) | The Shares of Common Stock are issuable upon conversion of 624,941 shares of Series A Preferred Stock owned by Insurance Marketing Solutions, LLC ("IMS") , a limited liability company organized in the state of Florida. |
(5) | There is no expiration date by which Series A Preferred Shares must be converted into Common Shares. |