FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 08/18/2005 |
3. Issuer Name and Ticker or Trading Symbol
Telzuit Medical Technologies, Inc. [ TZMT ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Beneficially Owned | |||
---|---|---|---|
1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
COMMON STOCK | 6,996(1) | I | By Midtown Partners & Co., LLC(2) |
COMMON STOCK | 225,000(1) | I | By FAMALOM, LLC(3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
---|---|---|---|---|---|---|---|
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: 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 | ||||
Series A Convertible Preferred Stock | 10/15/2005(4) | (7) | Common Stock | 31,815(5) | $0.6 | D | |
Common Stock Warrant (Right to Buy) | 05/06/2005 | 10/15/2005(6) | Common Stock | 15,625 | $0.6 | D | |
Common Stock Warrant (Right to Buy) | 07/12/2005 | 10/15/2005(6) | Common Stock | 31,815 | $0.8 | D | |
Common Stock Warrant (Right to Buy) | 06/22/2005 | 10/15/2005(6) | Common Stock | 55,107(1) | $0.6 | I | By Midtown Partners & Co., LLC(2) |
Common Stock Warrant (Right to Buy) | 06/22/2005 | 10/15/2005(6) | Common Stock | 40,000(1) | $0.8 | I | By Midtown Partners & Co., LLC(2) |
Common Stock Warrant (Right to Buy) | 06/22/2005 | 10/15/2005(6) | Common Stock | 140,000(1) | $0.6 | I | by FAMALOM, LLC(3) |
Common Stock Warrant (Right to Buy) | 06/22/2005 | 10/15/2005(6) | Common Stock | 140,000(1) | $0.8 | I | By FAMALOM, LLC(3) |
Explanation of Responses: |
1. The Reporting Person disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein, and the inclusion of these shares in this Report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. |
2. The Reporting Person owns, directly or indirectly, a portion of the issued and outstanding ownership interests of Midtown Partners & Co., LLC. |
3. The Reporting Person owns, directly or indirectly, a portion of the issued and outstanding ownership interests of FAMALOM, LLC. |
4. The shares of Series A Convertible Preferred Stock are convertible at any time after the "Conversion Date", which is defined as: (i) the Effective Date of the Issuer's SB-2 Registration Statement, which the Company plans to file on or about October 15, 2005; or (ii) the date that the Reporting Person has satisfied the minimum one-year holding requirements set forth in SEC Rule 144(d). |
5. This number assumes conversion as of the Conversion Date. Conversion of the Series A Preferred Stock at a later date may increase the number of underlying shares of common stock to adjust for any dividends accrued and unpaid on each share to the date such share is converted. |
6. The purchase right represented by the warrant is exercisable through and including the close of business on the date five (5) years from the date that the Issuer files a Registration Statement on Form SB-2 covering the Warrants, the underlying Warrant Shares and the shares of common stock. It is anticipated that the Issuer will file an SB-2 Registration Statement on or about October 15, 2005. The expiration date for the Warrants will depend on the actual date the Registration Statement is filed with the SEC. |
7. none. |
/s/ Chris D. Phillips | 09/23/2005 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |