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 |
Non Qualifed Stock Option
|
12/18/2012 |
06/18/2022 |
Common Stock
|
1,044,800
(3)
|
$
0.17
|
D
|
Â
|
Incentive Stock Option
|
12/18/2012 |
06/18/2022 |
Common Stock
|
255,200
(4)
|
$
0.17
|
D
|
Â
|
Series A Preferred Warrant
|
10/31/2011 |
10/31/2014 |
Common Stock
|
1,000
(5)
|
$
0.75
|
I
(1)
|
by Global Venture Investments, LLC
|
Series A Convertible Preferred
|
10/31/2011 |
Â
(6)
|
Common Stock
|
5,668
|
$
(6)
|
I
(6)
|
by Global Venture Investments, LLC
|
* |
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) |
Common stock of Issuer owned by Global Venture Investments, LLC, an entity owned and controlled by Reporting Person. |
(2) |
Common stock of Issuer granted to Reporting Person on February 9, 2012 pursuant to Issuer's 2012 Equity Incentive Plan and subject thereto. Grant of restricted stock subject to forfeiture. 50% becomes vested 6 months from grant date, 20% vests at the one year anniversary, 20% at 18 months and 10% at the two year anniversary, for so long as recipient remains an employee of, or consultant to, the Company. |
(3) |
Non-Qualified options to purchase Common Stock of Issuer granted outside of Plan. Vesting at the rate of 50% on the 6 month anniversary, 20% on the one year anniversary, 20% at the 18 month anniversary and 10% at the two year anniversary, for so long as recipient remains an employee of, or consultant to, the Company and subject to the terms and conditions of the Stock Option Agreement. |
(4) |
Incentive Stock Option to purchase Common Stock of Issuer granted pursuant to Issuer's 2012 Equity Incentive Plan and subject thereto. Vesting at the rate of 50% on the 6 month anniversary, 20% on the one year anniversary, 20% at 18 months from grant date and 10% on the two year anniversary from grant date, for so long as the recipient remains an employee of, or consultant to, the Company and subject to the terms and conditions of the Stock Option Agreement. |
(5) |
Warrant to purchase Series A Preferred stock of Issuer, and Common Stock issuable thereunder, held by Global Venture Investments, LLC, an entity owned and controlled by Reporting Person. |
(6) |
Series A Convertible Preferred shares issued to Global Venture Investments, LLC pursuant to a subscription in the Series A Private Placement Financing of October 14 2011. The entity is owned and controlled by Reporting Person. |