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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 | ||||||||
Stock Option (Right to Buy) | $ 4 | 12/16/2004 | D(1) | 100,000 | (1) | (1) | Common Stock | 100,000 | $ 0 (1) | 0 | D | ||||
Stock Option (Right to Buy) | $ 4 (2) | 12/16/2004 | A(1) | 50,000 | 06/17/2005 | 06/17/2015 | Common Stock | 50,000 (2) | $ 0 (1) | 50,000 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
HADDOCK GERALD W 210 WEST 6TH STREET SUITE 1206 FORT WORTH TX 76102 |
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Gerald W. Haddock | 12/16/2004 | |
**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 December 10, 2004, Reporting Person was granted by Issuer, in a transaction exempt under Rule 16b-3(d), an option to purchase, subject to antidilution provisions, up to one hundred thousand (100,000) shares of Issuer's common stock at an exercise price of $4.00 per share, in consideration of Reporting Person's agreement to provide Issuer with certain services. Acquisition of that option grant was reported by Reporting Person on a Form 4 Statement filed December 14, 2004. On December 16, 2004, that option grant was mutually rescinded ab initio by Reporting Person and Issuer in a transaction exempt under Rule 16b-3(e) and, in lieu thereof, Reporting Person was granted by Issuer, in a transaction exempt under Rule 16b-3(d), an option to purchase, subject to antidilution adjustments, fifty thousand (50,000) shares of Issuer's common stock at an exercise price of $4.00 per share, in consideration of Reporting Person's agreement to provide Issuer with certain consulting services. |
(2) | Exercise price and number of shares of common stock issuable upon exercise of option are both subject to anti-dilution provisions. |