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 |
Secured Convertible Note
|
08/20/2018 |
Â
(2)(3)
|
Common Stock, par value $0.001 per share
|
40,000
(4)
|
$
2.5
|
I
|
See Note
(1)
|
Common Stock Purchase Warrant
|
02/20/2018 |
02/20/2023 |
Common Stock, par value $0.001 per share
|
40,000
|
$
3
|
I
|
See Note
(1)
|
Common Stock Purchase Warrant
|
08/15/2019 |
08/15/2024 |
Common Stock, par value $0.001 per share
|
40,000
|
$
2.55
|
I
|
See Note
(1)
|
* |
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) |
Represents securities held of record by the Michael G. Klein Living Trust dated 3/25/2002. |
(2) |
The Secured Convertible Notes became convertible into common stock on the original date of issuance and are convertible into common stock at the option of the holder at any time and from time to time until August 20, 2019, subject to earlier repayment, redemption or conversion in accordance with their terms. |
(3) |
The Secured Convertible Notes Mature on August 20, 2019, subject to earlier repayment, redemption or conversion in accordance with their terms. |
(4) |
Consists of an aggregate principal amount of $100,000 of Secured Convertible Notes, which are initially convertible into 40,000 shares of common stock. |