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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 | ||||||||
Common Stock Warrant (Right to Buy) | $ 2.34 | 12/16/2013 | A | V | 38,096 (2) | 12/16/2013 | 12/16/2018 | Common Stock | 38,096 | $ 2.34 | 38,096 | I (3) | By Global Venture Investments LLC | ||
Common Stock Warrant (Right to Buy) | $ 2.25 | 01/03/2012 | 10/31/2014 | Common Stock | 334 | 334 | I (3) | By Global Venture Investments LLC | |||||||
Common Stock Warrant (Right to Buy) | $ 5.25 | 03/22/2013 | 03/22/2017 | Common Stock | 19,048 | 19,048 | I (3) | By Global Venture Investments LLC | |||||||
Non-Qualified Stock Option (Right to Buy) | $ 0.51 | 12/18/2012 | 06/18/2022 | Common Stock | 348,267 | 348,267 | D | ||||||||
Incentive Stock Option (Right to Buy) | $ 0.51 | 12/18/2012 | 06/18/2022 | Common Stock | 42,533 | 42,533 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Ingriselli Frank C 4125 BLACKHAWK PLAZA CIRCLE SUITE 201 DANVILLE, CA 94506 |
X | CEO and President |
/s/ Clark Moore, Attorney in Fact | 12/18/2013 | |
**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) | Reporting Persons holding includes 166,667 shares and 450,000 shares issued pursuant to restricted stock grants, 40,123 shares issued pursuant to an option exercise, 793,334 and 1890 transferred from Global Venture Investments, LLC, and 57,677 shares remaining from Founder's stock grant. |
(2) | Warrant to purchase common stock of Issuer granted to Reporting Person as consideration for Bridge Note amendment and deferral. |
(3) | Global Venture Investments, LLC is an entity 100% owned and controlled by Reporting Person. |