|
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 |
|
| |||||||||||||||||||||||||||||
|
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) |
||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Convertible Preferred Stock (1) | $ 5 | 05/02/2012 | P | 1,000,000 | (2) | (2) | Common Stock | 200,000 | $ 5 | 1,000,000 | D | ||||
Warrants (Right to Buy) (1) | $ 6 | 05/02/2012 | P | 125,000 | 05/02/2012 | 05/02/2020 | Common Stock | 125,000 | $ 1 | 125,000 | D | ||||
Warrants (Right to Buy) (1) | $ 7 | 05/02/2012 | P | 200,000 | 05/02/2012 | 05/02/2020 | Common Stock | 200,000 | $ 1 | 200,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
JCH Crenshaw Holdings, LLC 470 ORLEANS ST, 7TH FLOOR BEAUMONT, TX 77701 |
Director by Deputization |
/s/ J. Casey Crenshaw, President | 05/03/2012 | |
**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) | On May 2, 2012, JCH Crenshaw Holdings, LLC acquired 1,000,000 shares of Series A Convertible Preferred Stock of the issuer, warrants to acquire 125,000 shares of Common Stock of the issuer at a price of $6.00 per share and warrants to acquire 200,000 shares of Common Stock of the issuer at a price of $6.00 per share pursuant to a Securities Purchase Agreement between JCH Crenshaw Holdings, LLC and the issuer dated April 13, 2012. |
(2) | The Series A Convertible Preferred Stock is convertible into Common Stock at any time on a one-for-one basis, and has no expiration date. |