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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549ANNUAL STATEMENT 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 2270 (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 at End of Issuer's Fiscal Year (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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(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
05/12/11 Warrant | $ 0.45 | Â | Â | Â | Â | Â | 05/12-05:00/2011 | 05/12-05:00/2016 | Dais Common | Â | 9,978,165 | Â | ||
09/17/09 Warrant | $ 0.75 | Â | Â | Â | Â | Â | 09/17-05:00/2009 | 09/17-05:00/2014 | Dais Common | Â | 9,978,165 | Â | ||
10/09/2009 | $ 0.75 | Â | Â | Â | Â | Â | 10/09-05:00/2009 | 10/09-05:00/2014 | Dais Common | Â | 9,978,165 | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
SAMUELS LEONARD 1011 CENTENNIAL ROAD PENN VALLEY, PA 19072 |
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/s/ Leonard Samuels | 01/10-06:00/2014 | |
**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) | Includes 2,724,696 shares of common stock held jointly with Leah Kaplan-Samuels, my wife. Includes 5,860,969 shares of common stock held in Leonard Samuels' IRA accounts. Includes warrants as listed in Table II of this Form 5 exercisable for the purchase of shares of common stock. Includes 155,000 shares underlying warrants held jointly with Leah Kaplan-Samuels. |
 Remarks: 75,000 of the 10/09/09 warrants and all of the 09/17/2009 warrants are held jointly with Leah Kaplan-Samuels. The rest of the warrants are in Leonard Samuels' IRA accounts. |