UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
warrants to purchase common stock | 10/23/2013 | 10/23/2018 | common stock | 932,465 | $ 0.75 | I | By Alpha Venture Capital Partners, L.P. |
warrants to purchase common stock | 10/23/2013 | 10/23/2018 | common stock | 115,385 | $ 0.75 | I | By Alpha Venture Capital Fund, L.P. |
convertible promissory note | 09/26/2014 | 09/26/2016 | common stock | $ 2,000,000 | $ 1 | I | By Alpha Venture Capital Partners, L.P. |
warrants to purchase common stock | 09/26/2014 | 12/31/2019 | common stock | 250,000 | $ 0.5 | I | By Alpha Venture Capital Fund, L.P. |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
ALPHA ADVISORS, LLC P.O. BOX 2477 LAKELAND, FL 33806-2477 |
 |  X |  | indirect |
Alpha Venture Capital Partners, L.P. P.O. BOX 2477 LAKELAND, FL 33806 |
 |  X |  |  |
/s/Carl Dockery as Manager of Alpha Advisors, LLC | 07/17/2015 | |
**Signature of Reporting Person | Date | |
/s/Carl Dockery as Manager of Alpha Venture Capital Management, LLC, General Partner of Alpha Venture Capital Partners, L.P. | 07/17/2015 | |
**Signature of Reporting Person | Date |
* | 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). |
 Remarks: The securities reported on this Form 3 are owned directly by Alpha Venture Capital Partners, L.P.-AVC Partners-or Alpha Venture Capital Fund, L.P.-AVC Fund-as indicated in Tables I and II of this Form 3.  Alpha Venture Capital Management, LLC-AVC Management-is the general partner of AVC Partners and AVC Fund but does not make investment decisions on behalf of AVC Partners or AVC Funds.  As the investment advisor of AVC Partners and AVC Fund, Alpha Advisors, LLC-Alpha Advisors-has the exclusive authority to make all investment decisions on behalf of AVCP and AVC Fund.  Alpha Advisors does not directly receive dividends or proceeds of sale from the securities owned by AVC Partners or AVC Fund |