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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 | ||||||||
$382,250 8% Convertible Note | $ 0.737 | 06/08/2006 | C | 547,384 (6) | 11/26/2005(4) | 11/26/2006 | Common Stock | 547,384 (6) | $ 0.737 | 0 (5) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ADAMS DONALD E 370 CRESTMONT DRIVE SAN LUIS OBISPO, CA 93401 |
X |
/s/ DONALD E. ADAMS | 09/24/2007 | |
**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 upon the conversion of an 8% Convertible Note in the principal amount of $382,250 reported on Form 3, dated March 29, 2006, at a conversion price of $0.737 per share. |
(2) | Shares received in satisfaction of accrued and unpaid interest of Convertible Note described above. |
(3) | Shares purchased in a Private Placement under Regulation D of the Securities Act of 1933, as amended. |
(4) | Convertible Note was convertible into shares of Common Stock at any time at the sole discretion of the Reporting Person. |
(5) | Does not include (i) 1,116,667 shares of Common Stock issuable upon the exercise of a warrant at a purchase price of $0.935 per share and expiring on December 31, 2010 and (ii) 533,333 shares of Common Stock issuable upon the exercise of a warrant at a purchase price of $0.99per share and expiring on March 30, 2010. |
(6) | Consists of (i) 518,657 shares of Common Stock issued upon the conversion of the principal amount of the Convertible Note and (ii) 28,727 shares of Common Stock issued in satisfaction of accrued and unpaid interest on the Convertible Note. |