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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 purchase options | $ 0.48 (5) | 02/28/2012 | J(3) | 65,000 | 11/08/2009(4) | 02/28/2012 | Common stock | 65,000 | $ 0.48 (6) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Moorby Tony 7873 EASTGATE BOULEVARD MT. JULIET, TN 37122 |
None |
/s/ Tony Moorby by /s/ Steven L. Sample, PoA | 02/22/2013 | |
**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) | Shares returned to issuer pursuant to terms of Settlement Agreement and Release of even date herewith. |
(2) | Shares returned to issuer for cancellation and return to Issuer's treasury. |
(3) | Common stock purchase options returned to issuer pursuant to terms of Settlement Agreement and Release of even date herewith |
(4) | 50,000 common stock purchase options were exercisable on January 1, 2009, at an exercise price of $0.50 per share,; and, 15,000 common stock purchase options were exercisable at $0.10 per share, all of which options are now cancelled by issuer. |
(5) | Average exercise price of the common stock purchase options |
(6) | Average price based on options at issue dates |
(7) | Shares returned to giftor pursuant to terms of Settlement Agreement and Release of even date herewith. |