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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 A Convertible Preferred Stock | (1) | 08/10/2005 | C | 21,691 | (1) | (1) | Common Stock | 21,691 | $ 0 (1) | 0 | I | Held by Wife (2) | |||
Series A Convertible Preferred Stock | (1) | 08/10/2005 | C | 143,622 | (1) | (1) | Common Stock | 143,622 | $ 0 (1) | 0 | I | Held by Partisan Management Group (3) | |||
Series A Convertible Preferred Stock | (1) | 08/10/2005 | C | 213,190 | (1) | (1) | Common Stock | 213,190 | $ 0 (1) | 0 | I | Held by The Weldon Foundation (5) | |||
Series B Convertible Preferred Stock | (1) | 08/10/2005 | C | 57,061 | (1) | (1) | Common Stock | 57,061 | $ 0 (1) | 0 | I | Held by Wife (2) | |||
Series B Convertible Preferred Stock | (1) | 08/10/2005 | C | 27,880 | (1) | (1) | Common Stock | 27,880 | $ 0 (1) | 0 | I | Held by Partisan Management Group (3) | |||
Series B Convertible Preferred Stock | (1) | 08/10/2005 | C | 27,880 | (1) | (1) | Common Stock | 27,880 | $ 0 (1) | 0 | I | Held by The Weldon Foundation (5) | |||
Preferred Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 17,118 | 08/10/2005 | (4) | Series B Convertible Preferred Stock | 17,118 | $ 0 (6) | 0 | I | Held by Wife (2) | |||
Preferred Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 8,363 | 08/10/2005 | (4) | Series B Convertible Preferred Stock | 8,363 | $ 0 (6) | 0 | I | Held by Partisan Management Group (3) | |||
Preferred Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 8,363 | 08/10/2005 | (4) | Series B Convertible Preferred Stock | 8,363 | $ 0 (6) | 0 | I | Held by The Weldon Foundation (5) | |||
Common Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 17,118 | 08/10/2005 | (4) | Common Stock | 17,118 | $ 0 (6) | 17,118 | I | Held by Wife (2) | |||
Common Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 8,363 | 08/10/2005 | (4) | Common Stock | 8,363 | $ 0 (6) | 8,363 | I | Held by Partisan Management Group (3) | |||
Common Stock Warrants (Right to Buy) | $ 5.43 | 08/10/2005 | C | 8,363 | 08/10/2005 | (4) | Common Stock | 8,363 | $ 0 (6) | 8,363 | I | Held by The Weldon Foundation (5) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
WELDON NORMAN R 6 OCEAN CLUB DRIVE AMELIA ISLAND, FL 32034 |
X |
/s/ Thomas J. Etergino as Attorney-in-Fact for Norman R. Weldon | 08/15/2005 | |
**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 shares of Preferred Stock automatically converted on a 1-for-1 basis into Common Stock upon the closing of the Issuer's initial public offering. |
(2) | Dr. Weldon disclaims beneficial ownership of the securities held by his wife, except as to his pecuniary interest therein. |
(3) | Dr. Weldon is a Managing Director of Partisan Management Group. Dr. Weldon disclaims beneficial ownership of the securities held by this entity, except as to his pecuniary interest therein. |
(4) | Warrants expire on August 10, 2006 (one year from the date of the Issuer's initial public offering). |
(5) | Dr. Weldon is the President of The Weldon Foundation. Dr. Weldon disclaims beneficial ownership of the securities held by this entity, except as to his pecuniary interest therein. |
(6) | The shares of Series B Convertible Preferred Stock issuable upon conversion of the Warrants automatically converted on a 1-for-1 basis into Common Stock upon the closing of the Issuer's initial public offering. |