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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 A Convertible Preferred Stock | $ 10 | 10/13/2011 | J(4) | 205 | 10/13/2011 | (5) | Common Stock | 683 | $ 3 | 16,483 | D | ||||
Series A Convertible Preferred Stock | $ 10 | 10/13/2011 | J(4) | 205 | 10/13/2011 | (5) | Common Stock | 683 | $ 3 | 16,484 | I | By Trust (Spouse) | |||
Series B Convertible Preferred Stock | $ 10 | 06/30/2011 | (6) | Common Stock | 130,753 | 52,301 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ALLEN ROBERT W 3160 PINEBROOK RD PARK CITY, UT 84098 |
/s/ Robert W. Allen | 12/02/2011 | |
**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) | Shares issued in lieu of cash compensation for fees for services on the Company's Board of Directors. |
(2) | Shares were issued as bonus compensation. Issuance represents one-fifth of shares issued. The remaining shares are issued over a two year period. |
(3) | Price reflects fair market value of shares on the date of original issuance, November 21, 2008. |
(4) | Shares were issued in lieu of cash dividends payable on Series A Convertible Preferred Stock. |
(5) | Series A Convertible Preferred Stock remains convertible so long as the shares remain issued and outstanding. |
(6) | Series B Convertible Preferred Stock remains convertible so long as the shares remain issued and outstanding. |