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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Convertible Note (1) | $ 0.05 | Â | Â | Â | Â | Â | 04/30/2006 | 01/01/2016 | Common Stock | Â | 5,042,580 (2) | Â | ||
Option (4) | $ 0.05 | Â | Â | Â | Â | Â | 01/21/2014(5) | 01/20/2024 | Common Stock | Â | 500,000 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
NORTHWEST HAMPTON HOLDINGS LLC STUART LEVISON, ESQ. ALLEN & O'BRIEN, ONE EAST AVE. ROCHESTER, NY 14604 |
 X |  X |  President |  |
/s/ James Villa as sole member of Northwest Hampton Holdings, LLC | 02/12/2015 | |
**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) | Consists of the outstanding balance of a convertible note issued in 2003. |
(2) | Includes the number of shares issuable upon conversion of principal and accrued interest as of December 31, 2014. |
(3) | These securities are owned indirectly by James Villa as the sole member of Northwest Hampton Holdings, LLC. |
(4) | These common stock options are owned by James Villa. |
(5) | The options are exercisable to purchase one-third of the shares beginning on the 1/21/2014 grant date and to purchase an additional one-third of the shares on each of the first and second anniversaries of the date of grant. |