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 B Convertible Preferred Stock | Â (1) | Â (1) | Common Stock | 1,000 (2) | $ (2) | I | By Mayfair I, LLC |
Options to Purchase Common Stock | Â (4) | 09/13/2013 | Common Stock | 812 (3) (4) | $ 100 (3) | D | Â |
Options to Purchase Common Stock | Â (5) | 03/24/2014 | Common Stock | 400 (3) (5) | $ 100 (3) | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Luby Dallas W 1414 RALEIGH ROAD, SUITE 415 CHAPEL HILL, NC 27517 |
 X |  |  |  |
/s/ J. Adam Abram, Attorney-in-Fact | 08/08/2005 | |
**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) | All of the issuer's Series B Convertible Preferred Stock will be converted into Common Stock immediately prior to the closing of the issuer's initial public offering. |
(2) | Does not reflect accrued and unpaid dividends payable in Common Stock or a 10-for-1 stock split to be effective prior to the closing of the issuer's initial public offering. |
(3) | Does not reflect a 10-for-1 stock split, to be effective prior to the closing of the issuer's initial public offering. |
(4) | Of these 812 Options to Purchase Common Stock, 203 have vested, and the remainder will vest in equal installments on each of 9/4/05, 9/4/06 and 9/4/07. |
(5) | Of these 400 Options to Purchase Common Stock, 100 have vested, and the remainder will vest in equal installments on each of 3/25/06, 3/25/07 and 3/25/08. |
 Remarks: J. Adam Abram was granted a power of attorney to sign Form 3 on behalf of Mr. Luby pursuant to the Power of Attorney attached hereto as Exhibit 24. EXHIBIT INDEX - Exhibit 24 - Power of Attorney |