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) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Warrant to purchase Common Stock
(1)
|
11/09/2010 |
11/09/2012 |
Warrant to purchase Common Stock
|
187,500
|
$
0.2
|
D
|
Â
|
Warrant to purchase Common Stock
(2)
|
06/20/2011 |
06/20/2014 |
Warrant to purchase Common Stock
|
200,000
|
$
0.15
|
D
|
Â
|
Warrant to purchase Common Stock
(3)
|
09/30/2011 |
09/30/2014 |
Warrant to purchase Common Stock
|
200,000
|
$
0.15
|
D
|
Â
|
Warrant to purchase Common Stock
(4)
|
01/26/2012 |
01/26/2015 |
Warrant to purchase Common Stock
|
175,000
|
$
0.12
|
D
|
Â
|
Warrant to purchase Common Stock
(5)
|
07/17/2012 |
07/17/2015 |
Warrant to purchase Common Stock
|
100,000
|
$
0.15
|
D
|
Â
|
Convertible Note into Common Stock
(6)
|
06/29/2011 |
07/31/2014 |
Convertible Note into Common Stock
|
$
30,000
(7)
|
$
0.15
|
D
|
Â
|
* |
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) |
Warrant #510009 issued 11/09/2010 |
(2) |
Warrant #510020 issued 06/20/2011 |
(3) |
Warrant #510029 issued 09/30/2011 |
(4) |
Warrant #510030 issued 01/26/2012
Can be exercised at $0.12 for the 1st 18 months and $0.20 for the following 18 months |
(5) |
Warrant #510039 issued 07/17/2012 |
(6) |
Per Promissory Note dated 03/31/2011 - Lender may elect to receive payment of this Note and all accrued interest on the due date in restricted common stock of the Borrower |
(7) |
Promissory Note was issued for $30,000 with interest at a rate of ten percent (10%) per annum |