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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 | ||||||||
Series A Preferred Stock | $ 0.12 (1) | 01/28/2009 | P | 2,500,000 | 01/28/2009 | (2) | Common Stock | 12,500,000 | $ 0.6 | 2,500,000 | I | By fund (3) | |||
Series A Preferred Stock | $ 0.12 (1) | 01/28/2009 | P | 58,333 | 01/28/2009 | (2) | Common Stock | 291,665 | $ 0.6 | 58,333 | I | By fund (4) | |||
Series A Preferred Stock | $ 0.12 (1) | 01/28/2009 | P | 58,333 | 01/28/2009 | (2) | Common Stock | 291,665 | $ 0.6 | 1,725,001 | I | By fund (5) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
WAXMAN ALBERT S C/O PSILOS GROUP MANAGERS, L.L.C. 140 BROADWAY, 51ST FLOOR NEW YORK, NY 10005 |
X | X | ||
PSILOS GROUP PARTNERS II, L.P. 140 BROADWAY, 51ST FLOOR NEW YORK, NY 10011 |
X | |||
PSILOS GROUP PARTNERS L P 140 BROADWAY, 51ST FLOOR NEW YORK, NY 10011 |
X |
/s/ Brian F. Leaf, attorney-in-fact | 01/30/2009 | |
**Signature of Reporting Person | Date | |
Brian F. Leaf, attorney-in-fact | 01/30/2009 | |
**Signature of Reporting Person | Date | |
Brian F. Leaf, attorney-in-fact | 01/30/2009 | |
**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 Series A Preferred Stock are initially convertible into shares of the issuer's common stock on a 5-for-1 basis. |
(2) | The Series A Preferred Stock has no expiration date. |
(3) | Shares are owned of record by Psilos/ CareGuide Investment, L.P., Albert S. Waxman, a director of the issuer, is the senior managing member of Psilos Group Investors III, LLC, the general partner of Psilos/ CareGuide Investment, L.P., and therefore may be deemed to beneficially own the securities owned by Psilos/ CareGuide Investment, L.P. Dr. Waxman disclaims beneficial ownership of the reported securities herein except to the extent of his pecuniary interest therein. |
(4) | Shares are owned of record by Psilos Group Partners, L.P., Albert S. Waxman, a director of the issuer, is the senior managing member of Psilos Group Investors, LLC, the general partner of Psilos Group Partners, L.P., and therefore may be deemed to beneficially own the securities owned by Psilos Group Partners, L.P. Dr. Waxman disclaims beneficial ownership of the reported securities herein except to the extent of his pecuniary interest therein. |
(5) | Shares are owned of record by Psilos Group Partners II, L.P., Albert S. Waxman, a director of the issuer, is the senior managing member of Psilos Group Investors II, LLC, the general partner of Psilos Group Partners II, L.P., and therefore may be deemed to beneficially own the securities owned by Psilos Group Partners II, L.P. Dr. Waxman disclaims beneficial ownership of the reported securities herein except to the extent of his pecuniary interest therein. |