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 |
Series A Preferred Stock
(1)
|
(2)
|
(2)
|
Common Stock
|
100,000
(3)
|
$
2.5
(3)
|
D
|
|
Common Stock Warrant (Right to Buy)
(2)
(1)
|
04/07/2015 |
04/07/2020 |
Common Stock
|
20,000
|
$
5
|
D
|
|
* |
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) |
Pursuant to a Securities Purchase Agreement dated April 7, 2015, between the Reporting Person and the Issuer, the Reporting Person acquired 100,000 shares of Series A Preferred Stock and warrants to purchase 20,000 shares of the Issuer's common stock at an exercise price of $5.00 per share in exchange for $250,000. |
(2) |
The Series A Preferred Stock are automatically convertible in accordance with the Issuer's Certificate of Designation and Certificate of Correction, which are included as exhibits 3.1 and 3.2, respectively, to the Issuer's Form 8-K filed on April 7, 2015, and do not have an expiration date. |
(3) |
Subject to adjustment as specified in the Issuer's Certificate of Designation, which is included as exhibit 3.1 to the Issuer's Form 8-K filed on April 7, 2015. |