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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 | ||||||||
Convertible Security | $ 0.25 | 05/04/2010 | D(1) | 707,071 | 05/16/2008 | 05/16/2011 | Common Stock | 707,071 | $ 0.25 | 779,900 | D | ||||
Stock Purchase Option | $ 0.3 | 10/11/2010 | A(2) | 453,009 | 10/11/2011(3) | 10/11/2020 | Common Stock | 453,009 | $ 0.25 | 1,232,909 | D | ||||
Stock Purchase Option | $ 0.3 | 10/11/2010 | A(4) | 99,000 | 10/11/2011 | 10/11/2020 | Common Stock | 99,000 | $ 0.25 | 1,331,909 (5) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MCKENZIE MATTHEW MURDOCK 13120 SW BEDFORD ST TIGARD, OR 97224 |
X | COO |
/Matthew M. McKenzie/ | 01/07/2011 | |
**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) | The Reporting Person's portion of the Convertible Security, a promissory note, was forgiven in consideration for 10,101 Common shares reported 5/11/2010. |
(2) | Stock Purchase Option was granted as an annual employee bonus. |
(3) | Vesting: 113,252 shares at 10/11/2011, thereafter 9,438 shares vest monthly. |
(4) | Granted as an annual director bonus. Fully vests at 10/11/2011. |
(5) | The spouse of the filer is an employee of the issuer who owns in her individual name an option to pirchase 83,891 common shares at $0.25 per share. |