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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 |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
DOUGLAS KEVIN 125 E. SIR FRANCIS DRAKE BLVD., STE 400 LARKSPUR, CA 94939 |
Member of 13(d)(3) group | |||
JAMES & JEAN DOUGLAS IRREVOCABLE DESCENDANTS TRUST 1101 FIFTH AVE SUITE 360 SAN RAFAEL, CA 94901 |
Member of 13(d)(3) group | |||
DOUGLAS JAMES E III 1101 FIFTH AVE SUITE 360 SAN RAFAEL, CA 94901 |
Member of 13(d)(3) group | |||
DOUGLAS FAMILY TRUST 1101 FIFTH AVE SUITE 360 SAN RAFAEL, CA 94901 |
Member of 13(d)(3) group |
KEVIN DOUGLAS, By: /s/ Tim McGaw, attorney in fact | 11/10/2009 | |
**Signature of Reporting Person | Date | |
JAMES DOUGLAS AND JEAN DOUGLAS IRREVOCABLE DESCENDANTS? TRUST, By: /s/ Tim McGaw, attorney in fact | 11/10/2009 | |
**Signature of Reporting Person | Date | |
JAMES E. DOUGLAS III, By: /s/ Tim McGaw, attorney in fact | 11/10/2009 | |
**Signature of Reporting Person | Date | |
DOUGLAS FAMILY TRUST, By: /s/ Tim McGaw, attorney in fact | 11/10/2009 | |
**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) | These shares are held directly and jointly by Kevin Douglas and his wife, Michelle Douglas. |
(2) | Each of the reporting persons hereunder (individually, a 'Reporting Person' and, collectively, the 'Reporting Persons') may be deemed a member of a 'group' within the meaning of Section 13(d)(3) of the Securities Exchange Act of 1934, as amended (the 'Exchange Act'), or Rule 13d-5 promulgated under the Exchange Act with one or more of the other Reporting Persons. Although the Reporting Persons are reporting such securities as if they were members of a 'group,' the filing of this Form 4 shall not be deemed an admission by any Reporting Person that such Reporting Person is a beneficial owner of any securities other than those directly held by such Reporting Person. |
(3) | These shares are held directly by the James Douglas and Jean Douglas Irrevocable Descendants' Trust and indirectly by Kevin Douglas. Kevin Douglas and Michelle Douglas, husband and wife, are each a co-trustee of the James Douglas and Jean Douglas Irrevocable Descendants' Trust. |
(4) | These shares are held directly by the Douglas Family Trust and indirectly by Kevin Douglas. James E. Douglas, Jr. and Jean A. Douglas, husband and wife, are each a co-trustee of the Douglas Family Trust. |
(5) | These shares are held directly by James E. Douglas, III and indirectly by Kevin Douglas. |
Remarks: Exhibit 24.1 : Power of Attorney |