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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 Promoissory Note | $ 5 | 11/27/2013 | C | 1 | 11/27/2013 | (2) | Common Stodck | 9,026 | $ 40,000 | 104,510 | D | ||||
Convertible Promissory Note | $ 5 | 11/27/2013 | C | 1 | 11/27/2013 | (2) | Common Stock | 33,061 | $ 150,000 | 71,449 (3) | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
De Tarr Charles 5004 BEE CREEK ROAD SUITE 600 SPICEWOOD, TX 78669 |
FORMER VP FINANCE |
/s/ Charles De Tarr | 12/02/2013 | |
**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 shares of common stock were acquired upon the conversion of two convertible promissory notes, one in the principal amount of $40,000 issued to the reporting person on October 10, 2011 and one in the principal amount of $150,000 issued to the reporting person on May 22, 2012. |
(2) | The convertible promissory notes were required to be paid on the earlier of (i) the completion of the Company's initial public offering and (ii) December 31, 2013. Upon the completion of the Company's initial public offering, which occurred on November 27, 2013, the convertible promissory notes, including all accrued interest, were paid with shares of the Company's common stock at the public offering price. |
(3) | The reporting person continues to hold two options for the purchase of 47,743 shares of the Company's common stock and one warrant for the purchase of 23,706 shares of the Company's common stock. |