UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF 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. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A-4 Convertible Preferred Stock | Â (2) | Â (2) | Common Stock | 268,257 | $ (3) | I | KCEP Ventures II, L.P. (1) |
Series A-5 Convertible Preferred Stock | Â (2) | Â (2) | Common Stock | 33,735 | $ (3) | I | KCEP Ventures II, L.P. (1) |
Series B-3 Convertible Preferred Stock | Â (2) | Â (2) | Common Stock | 311,003 | $ (4) | I | KCEP Ventures II, L.P. (1) |
Series B-4 Convertible Preferred Stock | Â (2) | Â (2) | Common Stock | 39,112 | $ (4) | I | KCEP Ventures II, L.P. (1) |
Series D-1 Convertible Preferred Stock | Â (2) | Â (2) | Common Stock | 511,512 | $ (5) | I | KCEP Ventures II, L.P. (1) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
REISLER WILLIAM 233 WEST 47TH STREET KANSAS CITY, MO 64112 |
 X |  |  |  |
/s/ John Burtelow, Attorney-in-fact for William Reisler | 10/27/2004 | |
**Signature of Reporting Person | Date |
* | 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) | William Reisler is the Managing Director of KCEP II, L.C. which is the general partner of KCEP Ventures II, L.P. Mr. Reisler disclaims beneficial ownership of the shares owned by KCEP Ventures, L.P. except to the extent of his pecuniary interest therein. |
(2) | Convertible upon demand. All shares of preferred stock will convert automatically upon consummation of the Company's initial public offering. |
(3) | 1.303334-to-1. |
(4) | 1-to-1. |
(5) | 1.200083-to-1. |