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 | ||||
Common Stock Warrant | Â (1) | 06/14/2023 | Common Stock | (1) | $ (1) | D | Â |
Convertible Promissory Note | Â (2) | Â (2) | Common Stock | $ 1,500,000 (2) | $ (2) | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
STUART MILL VENTURE PARTNERS LP C/O STUART MILL PARTNERS LLC 252 N. WASHINGTON STREET FALLS CHURCH, VA 22046 |
 |  X |  |  |
/s/ Donald J. Glidewell, Donald J. Glidewell, Attorney-in-Fact | 08/01/2013 | |
**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) | The warrant is exercisable upon completion of the Issuer's initial public offering for a number of shares equal to $75,000 divided by 70% of the price per share in the Issuer's initial public offering and at an exercise price per share equal to 70% of the price per share in the Issuer's initial public offering. |
(2) | Lists original principal under the convertible promissory note as of March 15, 2012, the date of purchase. Upon completion of the Issuer's initial public offering, such principal, plus all accrued interest, will automatically convert into common stock at a price per share equal to 70% of the price per share in the Issuer's initial public offering |