| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
|||||||||||||||
| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
CASH TECHNOLOGIES INC [ TQ ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
||||||||||||||||||||||||
|
3. Date of Earliest Transaction
(Month/Day/Year) 09/09/2004 | ||||||||||||||||||||||||||
|
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
|
| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock | 09/09/2004 | X | 102,231 | A | $0.5 | 746,542(1) | I | By Ejada Limited Partnership | ||
| Common Stock | 09/17/2004 | X | 75,000 | A | $0.5 | 821,542(1) | I | By Ejada Limited Partnership | ||
| Common Stock | 01/31/2005 | J(2) | 400,000 | A | (2) | 1,221,542(1)(2) | I | By Ejada Limited Partnership | ||
| Common Stock | 09/14/2004 | J(3) | 78,947 | A | (3) | 98,947(3) | I | By 1994 Revocable Trust | ||
| Common Stock | 09/23/2004 | X | 52,631 | A | $0.95 | 367,631 | I | By Tikkun Olam Foundation | ||
|
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Series C 8% Convertible Preferred Stock | (4) | (4) | (4) | Common Stock | 480,769 | 480,769(4) | I | By Ejada Limited Partnership | |||||||
| Series D Warrants (right to buy) | $0.5 | 09/09/2004 | X | 102,231 | 01/09/2001 | 01/09/2006 | Common Stock | 102,231 | $0 | 0 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $1.5 | 09/09/2004 | J(5) | 102,231 | 09/09/2004 | 09/09/2009 | Common Stock | 102,231 | (5) | 102,231 | I | By Ejada Limited Partnership | |||
| Series G 6% Cumulative Convertible Preferred Stock | (6) | 09/10/2004 | P | 28,571 | 09/10/2004 | (6) | Common Stock | 28,571 | (6) | 28,571 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $2.5 | 09/10/2004 | P | 10,000 | 09/10/2004 | 09/10/2009 | Common Stock | 10,000 | (6) | 10,000 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $3.5 | 09/10/2004 | P | 15,000 | 09/10/2004 | 09/10/2009 | Common Stock | 15,000 | (6) | 15,000 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $1 | 09/14/2004 | J(3) | 50,000 | 09/14/2004 | 09/14/2009 | Common Stock | 50,000 | (3) | 50,000 | I | By 1994 Revocable Trust | |||
| Warrants (right to buy) | $0.5 | 09/17/2004 | X | 75,000 | 09/06/2002 | 09/06/2007 | Common Stock | 75,000 | $0 | 0 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $1.5 | 09/17/2004 | J(7) | 75,000 | 09/17/2004 | 09/17/2009 | Common Stock | 75,000 | (7) | 75,000 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $0.95 | 09/23/2004 | X | 52,631 | 10/30/2002 | 10/30/2007 | Common Stock | 52,631 | $0 | 0 | I | By Tikkun Olam Foundation | |||
| Warrants (right to buy) | $1.5 | 09/23/2004 | J(8) | 52,631 | 09/23/2004 | 09/23/2009 | Common Stock | 52,631 | (8) | 52,631 | I | By Tikkun Olam Foundation | |||
| Warrants (right to buy) | $1 | 12/14/2004 | J(9) | 25,000 | 12/14/2004 | 12/14/2009 | Common Stock | 25,000 | (9) | 25,000 | I | By 1994 Revocable Trust | |||
| Warrants (right to buy) | $1.75 | 01/10/2005 | J(10) | 240,000 | 01/10/2005 | 01/10/2010 | Common Stock | 240,000 | (10) | 240,000 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $1.75 | 02/01/2005 | J(11) | 90,000 | 02/01/2005 | 02/01/2010 | Common Stock | 90,000 | (11) | 90,000 | I | By Ejada Limited Partnership | |||
| Warrants (right to buy) | $1.75 | 02/01/2005 | J(12) | 60,000 | 02/01/2005 | 02/01/2010 | Common Stock | 60,000 | (12) | 60,000 | I | By Tikkun Olam Foundation | |||
| Warrants (right to buy) | $1.75 | 02/02/2005 | J(13) | 30,000 | 02/02/2005 | 02/02/2010 | Common Stock | 30,000 | (13) | 30,000 | I | By Ada Partners, LLC | |||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
|
| Explanation of Responses: |
| 1. The reporting persons' Form 4 dated 05/22/2003 overstated the share holdings of the Ejada Limited Partnership by 14,787 shares of common stock. Due to a clerical error, the reporting persons inaccurately reflected the receipt of 14,787 shares of common stock as a dividend payment. No such dividend payment was received. |
| 2. The Ejada Limited Partnership received 400,000 shares of common stock as repayment for a $400,000 loan that the Partnership made to the issuer. Pursuant to Section 16(b) of the Securities Exchange Act of 1934, securities acquired in connection with a debt previously contracted are exempt from Section 16(b). |
| 3. The Eric Butlein 1994 Revocable Trust received 78,947 shares of common stock and 50,000 warrants with an exercise price of $1 per share, as repayment for a $75,000 loan that the Trust made to the issuer. Pursuant to Section 16(b) of the Securities Exchange Act of 1934, securities acquired in connection with a debt previously contracted are exempt from Section 16(b). |
| 4. Ada Partners, LLC transferred 480,769 shares of Series C Convertible Preferred Stock to the Ejada Limited Partnership as repayment for a debt Ada Partners owed to the Partnership. The transfer was exempt from Section 16 of the Securities Exchange Act of 1934 under Rule 16a-13. |
| 5. The Ejada Limited Partnership acquired these warrants from the issuer as an incentive to exercise its 102,231 Series D Warrants on 09/09/04. |
| 6. The Series G Convertible Preferred Stock is convertible into common stock at any time following the issue date. The conversion price of the Series G Convertible Preferred Stock is 80% of the "market price" of the issuer's common stock at the time of the conversion, subject to a minimum of $1.75 per share and a maximum of $2.75 per share. The "market price" is the average of the closing prices of the issuer's common stock for the 20 trading days immediately preceding the conversion date. At the issuer's option, the issuer may require conversion when the "market price" reaches $9 per share. Ejada Limited Partnership paid the issuer $50,000 and received 28,571 shares of Series G Convertible Preferred Stock, 10,000 warrants with an exercise price of $2.50 per share and 15,000 warrants with an exercise price of $3.50 per share. |
| 7. The Ejada Limited Partnership acquired these warrants from the issuer as an incentive to exercise its 75,000 warrants with an exercise price of $0.50 per share on 09/17/04. |
| 8. The Tikkun Olam Foundation acquired these warrants from the issuer as an incentive to exercise its 52,631 warrants with an exercise price of $0.95 per share on 09/23/04. |
| 9. The Eric Butlein 1994 Revocable Trust received 25,000 warrants with an exercise price of $1 per share, as compensation for consulting services. |
| 10. Ejada Limited Partnership acquired these warrants from the issuer in connection with a $400,000 loan to the issuer. |
| 11. Ejada Limited Partnership acquired these warrants from the issuer in connection with a $50,000 loan and a $100,000 loan to the issuer. |
| 12. Tikkun Olam Foundation acquired these warrants from the issuer in connection with a $100,000 loan to the issuer. |
| 13. Ada Partners, LLC acquired these warrants from the issuer in connection with a $50,000 loan to the issuer. |
| Remarks: |
| The reporting persons for the purposes of this Form 4 are Mr. Eric Butlein, Ms. Jayne Butlein and the Ejada Limited Partnership, who constitute a "group" for purposes of Section 13(d) of the Securities Exchange Act of 1934. The information set forth in Items 2, 3, 4, 5 and 6 of the heading to this Form 4 are applicable to each reporting person. |
| Eric Butlein | 02/09/2009 | |
| Jayne Butlein | 02/09/2005 | |
| Eric Butlein, as General Partner for Ejada Limited Partnership | 02/09/2005 | |
| Jayne Butlein, as General Partner for Ejada Limited Partnership | 02/09/2005 | |
| ** 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 4 (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. | ||