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 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/18/2004 |
3. Issuer Name and Ticker or Trading Symbol
AVATECH SOLUTIONS INC [ avso.ob ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 | 190,245 | I | See Footnote 1(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 D Convertible Preferred Stock | 01/18/2004 | (2) | Common Stock | 1,000,837 | $0.3 | I | See Footnote 1(1) |
Stock Purchase Warrants | 11/19/2003 | 11/19/2004 | Common Stock | 666,666 | $0.45 | I | See Footnote 1(1) |
Stock Purchase Warrants | 06/01/2001 | 06/01/2004 | Common Stock | 9,375 | $6.67 | I | See Footnote 1(1) |
Stock Purchase Warrants | 02/01/2000 | 02/01/2005 | Common Stock | 45,652 | $43.33 | I | See Footnote 1(1) |
Stock Purchase Options | 07/01/2003 | 07/01/2013 | Common Stock | 6,000 | $0.17 | I | See Footnote 1(1) |
Stock Purchase Options | (3) | 10/30/2013 | Common Stock | 18,000 | $0.8 | I | See Footnote 1(1) |
Stock Purchase Options | (4) | 03/10/2010 | Common Stock | 2,250 | $63.33 | I | See Footnote 1(1) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. All reported securities are owned directly by Capstone Ventures SBIC, L.P. Capstone SBIC Management, Inc. is the general partner of Capstone Ventures SBIC, L.P. and Barbara L. Santry shares voting and dispositive power over the shares with Eugene J. Fischer. Mr. Fischer has been a director of the issuer and a reporting person since 2000. |
2. Series D Convertible Preferred Stock may be converted by the holder at any time after March 18, 2004 and will automatically convert or be redeemed on the occurrance of certain events. There is no automatic or mandatory conversion or redemtion on a fixed date. |
3. This option was immediately vested and exercisable wtih respect to 6,000 shares on October 30, 2003 and becomes vested and exercisable with respect to an additional 6,000 shares on each October 1 thereafter. |
4. This option became vested and exercisable with respect to 25% of the underlying shares of common stock on March 10, 2001 and becomes vested and exercisable with respect to an additional 25% of such shares on each March 10 thereafter. This option will be fully vested and exercisable on March 10, 2004. |
Barbara L. Santry by Beth O. MacLaughlin, Power of Attorney | 01/28/2004 | |
Capstone Ventures SBIC, L.P. by Beth O. MacLaughlin, Power of Attorney | 01/28/2004 | |
Capstone SBIC Management, Inc. by Beth O. MacLaughlin, Power of Attorney | 01/28/2004 | |
** 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. |