|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 |
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
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 2270 (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 at End of Issuer's Fiscal Year (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
|||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Common Stock Warrants | $ 0.4 | Â | Â | 3 | Â | Â | 11/30/2006 | 11/29/2011 | Common Stock | Â | 1,666,667 | Â | ||
Common Stock Warrants | $ 0.4 | Â | Â | 3 | Â | Â | 11/30/2006 | 11/29/2011 | Common Stock | Â | 2,153,647 | Â | ||
Series B Convertible Preferred Stock | $ 0.5 | 10/29/2007 | Â | P4 | 11,000 | Â | Â (2) | Â (2) | Common Stock | $ 0.5 | 1,100,000 | Â | ||
Common Stock Warrants | $ 0.6 | 10/29/2007 | Â | P4 | 486,980 | Â | Â (3) | Â (2) | Common Stock | (4) | 486,980 | Â | ||
Common Stock Warrants | $ 0.23 | 05/13/2010 | Â | P4 | 869,566 | Â | Â (3) | 05/12/2015 | Common Stock | (5) | 869,566 | Â | ||
Series D Convertible Preferred Stock | $ 0.16 | 06/21/2010 | Â | P4 | 13,500 | Â | Â (2) | Â (2) | Common Stock | $ 0.16 | 1,350,000 | Â | ||
Common Stock Warrants | $ 0.19 | 06/21/2010 | Â | P4 | 675,000 | Â | Â (3) | 06/20/2015 | Common Stock | (6) | 675,000 | Â | ||
Common Stock Options | $ 0.17 | 08/13/2010 | Â | A4 | 62,500 | Â | Â (7) | 08/11/2020 | Common Stock | $ 0.17 | 62,500 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SARKOWSKY HERMAN 1201 3RD AVENUE SUITE 5450 SEATTLE, WA 98101 |
 X |  X |  |  |
Herman Sarkowsky | 04/08/2011 | |
**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) | Issued in connection with a Preferred Stock Dividend paid in Common Stock. |
(2) | None |
(3) | Immediately |
(4) | These warrants were part of a purchase of Series B Convertible Preferred Stock, as described above. |
(5) | These stock warrants were issued in connection with a note to the issuer on 05-13-2010, and vested monthly as long as the note was outstanding. This note was paid off with the issuer's financing closed on 6/21/2010. |
(6) | These warrants were part of a purchase of Series D Convertible Preferred Stock, as described above. |
(7) | 31,250 options become exercisable on 9/30/2010, 31,250 options become exercisable on 12/31/2010. |