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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 | (2) | 08/12/2005 | C | 220 | (4) | (4) | Common Stock | 4,400 (5) | (2) | 0 | D | ||||
Series B Convertible Preferred Stock | (2) | 08/12/2005 | C | 1,000 | (4) | (4) | Common Stock | 10,000 (5) | (2) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
FLEISHMAN JOEL LAWRENCE 1414 RALEIGH ROAD, SUITE 415 CHAPEL HILL, NC 27517 |
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/s/ E. Caperton Thomas, Attorney-in-Fact | 08/16/2005 | |
**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) | Reflects the conversion of all of the reporting person's preferred stock into Common Stock plus accrued dividends paid in Common Stock. |
(2) | Price not applicable to conversion of preferred stock into Common Stock. |
(3) | The amount of shares of Common Stock reported herein includes 1,000 shares owned indirectly by the reporting person in the Joel L. Fleishman Revocable Trust. |
(4) | All of the reporting person's Series A and Series B Convertible Preferred Stock was converted into Common Stock immediately prior to the closing of the issuer's initial public offering. |
(5) | Reflects a 10-for-1 stock split effected immediately prior to the closing of the issuer's initial public offering. |
Remarks: Ms. E. Caperton Thomas was granted power of attorney to sign Form 4 on behalf of Mr. Fleishman. |