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) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Convertible Promissory Note ($100,000.00)
(2)
|
07/06/2011 |
07/05/2012(3)
|
Common Stock
|
1,111,111
|
$
0.09
|
I
|
By Phillip A. Ward Trust
|
Convertible Promissory Note ($157,656.14)
(2)
|
08/15/2011 |
08/15/2012(3)
|
Common Stock
|
1,751,733
|
$
0.09
|
I
|
By Phillip A. Ward Life Insurance Trust
|
Warrants
|
07/06/2011 |
07/05/2016 |
Common Stock
|
1,111,111
|
$
0.125
|
I
|
By Phillip A. Ward Trust
|
Warrants
|
08/15/2011 |
08/14/2016 |
Common Stock
|
1,751,735
|
$
0.125
|
I
|
By Phillip A. Ward Trust Insurance Trust
|
Warrants
|
05/07/2010 |
05/07/2015 |
Common Stock
|
100,000
|
$
0.176
|
D
|
Â
|
Warrants
|
05/07/2010 |
05/07/2015 |
Common Stock
|
194,118
|
$
0.17
|
D
|
Â
|
Warrants
|
05/07/2010 |
05/07/2015 |
Common Stock
|
555,556
|
$
0.18
|
D
|
Â
|
Warrants
|
05/07/2010 |
07/01/2018 |
Common Stock
|
194,118
|
$
0.17
|
D
|
Â
|
Warrants
|
05/07/2010 |
07/01/2018 |
Common Stock
|
555,556
|
$
0.18
|
D
|
Â
|
Warrants
|
11/14/2006 |
07/01/2018 |
Common Stock
|
555,556
|
$
0.18
|
D
|
Â
|
Stock Options (right to buy)
|
Â
(4)
|
07/24/2022 |
Common Stock
|
373,026
|
$
0.076
|
D
|
Â
|
* |
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) |
Mr. Ward disclaims beneficial ownership of the shares held by his spouse, and this report shall not be deemed to be an admission that Mr. Ward is, for the purposes of Section 16 or otherwise, the beneficial owner of such shares. |
(2) |
Interest of 10% per annum on such note may be paid, at the issuer's option, in cash or common stock. |
(3) |
Maturity date. |
(4) |
198,026 of the options vested on the date of grant, and the balance of 175,000 options will vest at the end of the 2012-2013 fiscal year provided that Mr. Ward has attended at least 80% of the meetings of the Issuer's Board of Directors during such portion of the fiscal year that Mr. Ward has been a director of the Issuer. |