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) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
9% Convertible Subordinated Promissory Notes
|
(4)
|
08/21/2004 |
Common Stock
|
1,033,363
|
$
9.4207
|
I
|
See note (3).
|
* |
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). |
(1) |
The Reporting Person disclaims beneficial ownership of such securities, except to the extent, if any, of the Reporting Person's pecuniary interest therein. See note (3). |
(2) |
Based on information provided by another person (the "Other Person"). The Reporting Person has no responsibility for the accuracy or completeness of such information. |
(3) |
The Reporting Person does not own any securities of the issuer, but may be deemed to be a member of a group, within the meaning of Rule 13d-5 under the Securities Exchange Act of 1934, which may be deemed to beneficially own the reported securities. The securities reported in column 2 of Table I and in column 3 of Table II are owned by the Other Person who may be deemed to be a member of such group. The Reporting Person has a contractual right to receive a portion of the proceeds of the sale of such securities reported in column 2 of Table I and in column 3 of Table II under certain circumstances. Neither the filing of this Form 3 nor any of the information contained herein shall be construed as an admission that the Reporting Person has formed or is a member of any such group, or beneficially owns or has a pecuniary interest in any such securities. See note (1). |
(4) |
Based upon information provided by the Other Person, $11,000,000 aggregate principal amount of 9% convertible subordinated promissory notes of the issuer were automatically convertible on August 21, 2004 unless converted earlier at the option of the Reporting Person upon a change of control of the issuer. |