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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 | ||||||||
| Series B-2 Convertible Preferred Stock | $ 0.5 | 09/30/2009 | P | 162,500 | (3) | (3) | Common Stock | 650,000 | $ 2 (4) | 1,012,500 | I | By 10X Fund, LP (5) (6) (7) | |||
| Class A-1 Warrant (right to buy) | $ 0.5 | 09/30/2009 | P | 1 | 09/30/2009 | 09/30/2014 | Common Stock | 325,000 | $ 0 (4) | 5 | I | By 10X Fund, LP (5) (6) (7) | |||
| Class A-2 Warrant (right to buy) | $ 0.5 | 09/30/2009 | P | 1 | 09/30/2009 | 09/30/2014 | Common Stock | 325,000 | $ 0 (4) | 5 | I | By 10X Fund, LP (5) (6) (7) | |||
| Class B Warrant (right to buy) | $ 0.5 | 09/30/2009 | P | 1 | 09/30/2009 | 09/30/2014 | Common Stock | 1,300,000 | $ 0 (4) | 5 | I | By 10X Fund, LP (5) (6) (7) | |||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| CZIRR JAMES C 425 JANISH DR SANDPOINT, ID 83864 |
X | X | ||
| /s/ Robert J. Mottern, as attorney in fact for James C. Czirr | 10/06/2009 | |
| **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) | Reporting Person received additional shares of Issuer's common stock as dividends in the amount of 6,000 shares. Such shares are held in by a revocable trust in which Reporting Person is the sole trustee and sole beneficiary. The number of shares issuable in payment of dividends is based upon the market price of the common stock, subject to a minimum price of $1.00 per share. The price reported is the closing price of the common stock on the date the shares were issued. |
| (2) | On September 30, 2009, 10X Fund, L.P. received 213,136 shares of Common Stock of the Issuer in satisfaction of dividends on shares of Series B-1 and B-2 Convertible Preferred Stock owned by 10X Fund, L.P. Dividends on the Preferred Stock are payable in shares of the Issuer's Common Stock valued at $0.50 per share, with regard to the actual market price of the Common Stock at the time of issuance. The market value of the Common Stock at the time of its issuance was less than $0.50 per share. |
| (3) | Each share of Series B-2 Convertible Preferred Stock is convertible into four shares of Issuer's common stock at a conversion price of $0.50 per share (subject to customary anti-dilution protection adjustments) at the option of (a) the holder, at any time and (b) Issuer, at any time after September 30, 2010 (and upon 10 days notice) if the Issuer's common stock is quoted at or above $1.50 per share for 15 consecutive trading days and an effective registration statement regarding the underlying shares of Issuer's common stock is in effect (subject to certain monthly volume limits). The shares of Series B-2 Convertible Preferred Stock do not expire. |
| (4) | On September 30, 2009, 10X Fund, L.P. purchased (a) 162,500 shares of Series B-2 Preferred Stock, (b) one Class A-1 Warrant to purchase 325,000 shares of Common Stock for $0.50 per share, (c) one Class A-2 Warrant to purchase 325,000 shares of Common Stock for $0.50 per share, and (d) one Class B Warrant to purchase 1,300,000 shares of Common Stock for $0.50 per share, for aggregate consideration of $325,000. |
| (5) | Reporting Person is a managing member of 10X Capital Management, LLC, a Florida limited liability company acting as the general partner of 10X Fund, L.P., a Delaware limited partnership, and as such, may be deemed to have indirect beneficial ownership of all or a portion of the securities owned directly by 10X Fund, L.P., such portion being equal to 10X Capital Management, LLC's (a) 20% interest in the profits of 10X Fund, L.P., (b) interest in any securities which are used to pay a 2% annual management fee to 10X Capital Management, LLC, and (c) interest in one-half of the Class B Warrants acquired by 10X Fund, L.P. in all closings other than the initial closing held on February 12, 2009, less one Class B Warrant which 10X Capital Management, LLC has committed to reallocate to investors in all prior closings until each such investor has one (1) additional Class B Warrant for each dollar invested. |
| (6) | Any such deemed indirect beneficial ownership may also be reduced by Mr. Czirr's proportional ownership in 10X Capital Management, LLC. Mr. Czirr disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. |
| (7) | Excludes (i) up to 1,087,500 shares of Series B-2 Preferred Stock convertible into 4,350,000 shares of Common Stock; (ii) Class A-1 Warrants exercisable to purchase up to 2,175,000 shares of Common Stock; (iii) Class A-2 Warrants exercisable to purchase up to 2,175,000 shares of Common Stock; and (iv) Class B Warrants exercisable to purchase up to 8,700,000 shares of Common Stock that 10X Fund, L.P. may purchase from Issuer within 60 days of the date hereof pursuant to a Securities Purchase Agreement dated February 12, 2009, as amended on August 11, 2009, between Issuer and 10X Fund, L.P. |