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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 | ||||||||
Stock Options (right to purchase) | $ 4.64 | 06/02/2016 | A | 750 | 02/01/2016 | 06/01/2021 | Common Stock | 750 | $ 0 | 15,250 | D | ||||
Warrants | $ 5 | 08/19/2016 | P | 2,436 | 08/19/2016 | 07/31/2021 | Common Stock | 2,436 | $ 0 | 2,436 | I | See Note (3) | |||
Convertible Notes | $ 2.25 | 11/23/2016 | P | $ 100,000 | 11/23/2016 | 11/30/2018 | Common Stock | 44,444 | $ 100,000 | $ 304,183 | D | ||||
Convertible Note | (4) | 11/30/2016 | C | $ 204,183 | 08/19/2016 | 12/31/2017 | Common Stock (4) | (4) | $ 204,183 | $ 100,000 | D | ||||
Convertible Note | (4) | 11/30/2016 | C | $ 60,000 | 08/19/2016 | 12/31/2017 | Common Stock (4) | (4) | $ 60,000 | 0 | I | See Note (3) | |||
Series A Preferred Stock | $ 4.92 | 11/30/2016 | C | 23,291 (5) | 11/30/2016 | (6) | Common Stock | 47,338 | $ 232,910 | 91,309 | D | ||||
Series A Preferred Stock | $ 4.92 | 11/30/2016 | C | 6,036 (5) | 11/30/2016 | (6) | Common Stock | 12,268 | $ 60,360 | 6,036 | I | See Note (3) | |||
Convertible Notes | $ 2.63 | 12/22/2016 | P | $ 200,000 | 12/22/2016 | 11/30/2018 | Common Stock | 76,045 | $ 200,000 | $ 300,000 | D | ||||
Warrants | $ 3 | 12/22/2016 | P | 15,210 | 12/22/2016 | 11/30/2021 | Common Stock | 15,210 | $ 0 | 77,089 | D | ||||
Warrants | $ 3 | 12/22/2016 | P | 44,677 | 12/22/2016 | 11/30/2021 | Common Stock | 44,677 | $ 50 | 185,984 | I | See Note (7) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
TAGLICH ROBERT 790 NEW YORK AVENUE, SUITE 209 HUNTINGTON, NY 11743 |
X |
/s/ Robert F. Taglich | 12/27/2016 | |
**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) | Represents shares owned by Taglich Brothers, Inc., of which the Reporting Person is Managing Director. |
(2) | Owned by Tag/Kent Partners, of which Reporting Person is a General Partner. |
(3) | Custodian for children under NY UGMA |
(4) | Converted into shares of Series A Convertible Preferred Stock ("Series A Preferred Stock") at $10 per share upon filing of Certificate of Amendment increasing number of authorized shares of Preferred Stock. Until automatically converted into shares of Series A Preferred Stock, the Note had been convertible into shares of Common Stock at an exercise price of $4.92 per share, the conversion price of the Series A Preferred Stock. |
(5) | Includes shares received in lieu of cash dividends on December 15, 2016. |
(6) | There is no expiration date. |
(7) | Represents Placement Agent Warrants received by Taglich Brothers, Inc., of which the Reporting Person is Managing Director, which acted as placement agent for the sale of Issuer's 8% Subordinated Convertible Notes in December 2016. |