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 | ||||
Series A Preferred Stock | 06/30/2009 | Â (1) | Common Stock | 530,000 | $ 0.2 | D | Â |
Series A Preferred Stock | 06/30/2009 | Â (1) | Common Stock | 530,000 | $ 0.2 | I | Owned by trust (2) |
Series A Preferred Stock | 06/30/2009 | Â (1) | Common Stock | 25,000 | $ 0.2 | I | Owned by trust (3) |
Series A Preferred Warrants | 06/30/2009 | 06/30/2014 | Series A Preferred Stock (4) | 53 | $ 1,250 | D | Â |
Series A Preferred Warrants | 06/30/2009 | 06/30/2014 | Series A Preferred Stock (4) | 53 | $ 1,250 | I | Owned by trust (2) |
Series A Preferred Warrants | 06/30/2009 | 06/30/2014 | Series A Preferred Stock (5) | 2 | $ 1,250 | I | Owned by trust (3) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SEVERANCE H LEIGH 14282 E. CALEY AVE. AURORA, CO 80016 |
 |  X |  |  |
/s/ H. Leigh Severance | 07/10/2009 | |
**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 Series A Preferred Stock does not have an expiration date. |
(2) | Owned by the H.L. Severance, Inc. Profit Sharing Plan and Trust of which the Reporting Person is a controlling person. |
(3) | Owned by the H.L. Severance, Inc. Pension Plan and Trust of which the Reporting Person is a controlling person. |
(4) | The 53 shares of Series A Preferred Stock are convertible into 265,000 shares of Common Stock of the Issuer. |
(5) | The 2 shares of Series A Preferred Stock are convertible into 10,000 shares of Common Stock of the Issuer. |