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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 Convertible Preferred Stock | (1) | 02/26/2014 | C(1) | 171,500 | (1) | (1) | Common Stock | 171,500 | $ 0 | 0 | D | ||||
Series A Preferred Stock Warrant (right to buy) | $ 4.5 | 02/26/2014 | M(2) | 68,625 | 07/01/2012 | 06/30/2015 | Common Stock | 68,625 | $ 0 | 0 | D | ||||
Series A Preferred Stock Warrant (right to buy) | $ 4.5 | 02/26/2014 | M(2) | 60,000 | 08/31/2012 | 06/30/2015 | Common Stock | 60,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
GPG SSF Investment 5910 N. CENTRAL EXPRESSWAY SUITE 200 DALLAS, TX 75206 |
Exit filing, below 10% | |||
Green Park & Golf Ventures, LLC 5910 N. CENTRAL EXPRESSWAY SUITE 200 DALLAS, TX 75206 |
Exit filing, below 10% | |||
Heighten Clay M 5910 N. CENTRAL EXPRESSWAY SUITE 200 DALLAS, TX 75206 |
Exit filing, below 10% | |||
Soderstrom Carl D 5910 N. CENTRAL EXPRESSWAY SUITE 200 DALLAS, TX 75206 |
Exit filing, below 10% |
/s/ GPG SSF Investment, LLC By: Carl D. Soderstrom, Managing Director of Green Park & Golf Ventures, LLC | 02/27/2014 | |
**Signature of Reporting Person | Date | |
/s/ Greenpark Golf Ventures, LLC, By: Carl Soderstrom, its Managing Director | 02/27/2014 | |
**Signature of Reporting Person | Date | |
/s/ Clay M. Heighten, M.D. | 02/27/2014 | |
**Signature of Reporting Person | Date | |
/s/ Carl D. Soderstrom | 02/27/2014 | |
**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) | These securities automatically converted into Issuer's common stock on a one-for-one basis upon consummation of Issuer's initial public offering ("IPO") and had no expiration date. |
(2) | These securities were cashlessly exercised immediately prior to Issuer's IPO and automatically converted into shares of Issuer's common stock on a one-for-one basis. |
Remarks: These securities are held by a group consisting of GPG SSF Investment, LLC, Green Park & Golf Ventures, LLC, Clay M. Heighten, M.D. and Carl D. Soderstrom. All of these securities are owned directly by GPG SSF Investment, LLC. These securities may be deemed to be beneficially owned by Green Park & Golf Ventures, LLC, as a managing partner of GPG SSF Investment, LLC, and Clay M. Heighten, M.D. and Carl D. Soderstrom, each as a principal of Green Park & Golf Ventures, LLC. Following the IPO, the reporting persons are no longer 10% owners. |