UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Options | 10/09/2013(4) | 10/09/2023 | Common Stock | 3,000,000 | $ 0.605 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Nickolas Steven Paul 14301 NORTH 87 STREET, SUITE 109 SCOTTSDALE, AZ 85260 |
 X |  X |  President CEO Chairman |  |
WIN INVESTMENTS, LLC 14301 NORTH 87 STREET SUITE 109 SCOTTSDALE, AZ 85260 |
 |  X |  |  |
LIFEWATER INDUSTRIES, LLC 14301 NORTH 87 STREET, SUITE 109 SCOTTSDALE, AZ 85260 |
 |  X |  |  |
/s/ Steven Nickolas | 10/25/2013 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 5(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) | Steven P. Nickolas is the manager of WiN Investments, LLC and holds voting and dispositive control over these shares. |
(2) | Steven P. Nickolas is the manager of Lifewater Industries, LLC and holds voting and dispositive control over these shares. |
(3) | The Series A Preferred Stock has 10 votes per share and is not convertible into shares of common stock. |
(4) | The stock options vest as follows: (i) 1,000,000 on October 9, 2013; and (ii) 500,000 per quarter until fully vested. |