Statement of Changes in Beneficial Ownership (4)
June 20 2014 - 5:41PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
CIABATTONI LIVING TRUST U/A/D AUGUST 17, 2000
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2. Issuer Name
and
Ticker or Trading Symbol
First Physicians Capital Group, Inc.
[
TISG.OB
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
__
X
__ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
16 LAGUNITA DRIVE
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3. Date of Earliest Transaction
(MM/DD/YYYY)
6/15/2010
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(Street)
LAGUNA BEACH, CA 92561
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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6/15/2010
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X
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60000
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A
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$0.50
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60000
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D
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Common Stock
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2/3/2014
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O
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3500000
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A
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$0.01
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3560000
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Common Stock Warrant (Right to Buy)
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$0.3125
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1/1/2014
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P
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1814400
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1/1/2014
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1/1/2019
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Common Stock
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1814400
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$0.00
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1814400
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D
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Common Stock Warrant (Right to Buy)
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$0.50
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6/15/2010
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X
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60000
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5/24/2007
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5/24/2009
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Common Stock
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60000
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$0.00
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0
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D
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Series 6-A Convertible Preferred Stock
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$0.3125
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7/24/2012
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P
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100
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7/24/2012
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(1)
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Common Stock
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2240000
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$1000.00
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700
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D
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Series 6-A Convertible Preferred Stock
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$0.3125
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9/4/2012
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P
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75
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9/4/2012
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(1)
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Common Stock
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2480000
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$1000.00
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775
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D
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Series 6-A Convertible Preferred Stock
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$0.3125
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5/30/2013
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P
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155
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5/30/2013
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(1)
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Common Stock
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2976000
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$1000.00
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930
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D
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Convertible Promissory Note
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$0.625
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7/6/2011
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P
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$100000.00
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7/6/2011
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6/30/2014
(3)
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Common Stock
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160000
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$100000.00
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$1100000.00
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D
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Convertible Promissory Note
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$0.625
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8/1/2012
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J
(2)
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$175000.00
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2/11/2009
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6/30/2014
(3)
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Common Stock
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280000
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$925000.00
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$925000.00
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D
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Convertible Promissory Note
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$0.625
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4/7/2014
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J
(2)
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$825000.00
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2/11/2009
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6/30/2014
(3)
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Common Stock
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1495408
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$934360.00
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0
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D
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Common Stock Warrant (Right to Buy)
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$0.50
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2/6/2010
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P
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250000
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2/6/2010
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4/6/2012
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Common Stock
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250000
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$0.00
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250000
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D
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Common Stock Warrant (Right to Buy)
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$0.75
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2/6/2010
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P
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166667
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2/6/2010
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4/6/2012
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Common Stock
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166667
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$0.00
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166667
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D
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Explanation of Responses:
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(
1)
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No expiration date.
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(
2)
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On April 7, 2014, the Issuer elected to repay before maturity all outstanding principal and interest under all of its convertible promissory notes.
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(
3)
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In January 2014, the Reporting Person agreed to extend the maturity of the convertible promissory note to June 30, 2014.
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Remarks:
Exhibit 99.1 - Joint Filer Information
Exhibit 99.2 - Joint Filer Information
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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CIABATTONI LIVING TRUST U/A/D AUGUST 17, 2000
16 LAGUNITA DRIVE
LAGUNA BEACH, CA 92561
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X
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CIABATTONI ANTHONY J
16 LAGUNITA DRIVE
LAGUNA BEACH, CA 92651
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X
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CIABATTONI JANE G.
16 LAGUNITA DRIVE
LAGUNA BEACH, CA 92651
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X
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Signatures
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/s/ Anthony J. Ciabattoni, Manager
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6/20/2014
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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