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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-1 Common Stock | (2) | 06/07/2006 | C | 44,036 | (2) | (2) | Common Stock | 157,208 | (2) | 0 | I | See Footnote 3 (3) | |||
Series A-1 Common Stock | (2) | 06/07/2006 | C | 15,000 | (2) | (2) | Common Stock | 53,550 | (2) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Molson R Ian C/O ALPHATEC HOLDINGS, INC. 2051 PALOMAR AIRPORT ROAD CARLSBAD, CA 92011 |
X |
/s/ Daren Graham, Attorney-in-fact | 06/09/2006 | |
**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 Series A-1 Preferred Stock was redeemed by the Issuer upon the closing of the Issuer's initial public offering for 38,515 shares of Common Stock, 33,184 shares of New Redeemable Preferred Stock and cash. |
(2) | There is no expiration date. Each share of Series A-1 Common Stock converted into common stock on a 3.57-for-1 basis effective upon the closing of the Issuer's initial public offering. |
(3) | The stockholder is the Swiftsure Trust. R. Ian Molson, a director of the Issuer, controls Nantel Investments, Ltd., which is a beneficial owner of the Swiftsure Trust. |
(4) | Each share of Series A-1 Common Stock converted into common stock on a 3.57-for-1 basis effective upon the closing of the Issuer's initial public offering. |
(5) | In payment of dividends accrued on the Series A-1 Common Stock, the Reporting Person received 3,809 shares of Common Stock, 3,282 shares of New Redeemable Preferred Stock and cash. |
(6) | These shares are subject to a 5-year lapsing repurchase right of the Issuer, which will lapse in annual installments on the anniversary of the grant date. |
(7) | In payment of dividends accrued on the Series A-1 Common Stock, the Reporting Person received 581 shares of Common Stock, 550 shares of New Redeemable Preferred Stock and cash. |