-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, IkQ8gOgvNmOQtTCliyrMdC35pQtGiw/1npBUGyNm+Szh5Qf8A/o21O7fsVQI8EQx Gn3DBdjGA6erMIjj9wkDDA== 0001005477-08-005941.txt : 20080930 0001005477-08-005941.hdr.sgml : 20080930 20080930191514 ACCESSION NUMBER: 0001005477-08-005941 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20080929 FILED AS OF DATE: 20080930 DATE AS OF CHANGE: 20080930 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PepperBall Technologies, Inc. CENTRAL INDEX KEY: 0001216199 STANDARD INDUSTRIAL CLASSIFICATION: ORDNANCE & ACCESSORIES, (NO VEHICLES/GUIDED MISSILES) [3480] IRS NUMBER: 201978398 STATE OF INCORPORATION: CO FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 6142 NANCY RIDGE DRIVE STREET 2: SUITE 101 CITY: SAN DIEGO STATE: CA ZIP: 92121 BUSINESS PHONE: 858-638-0236 MAIL ADDRESS: STREET 1: 6142 NANCY RIDGE DRIVE STREET 2: SUITE 101 CITY: SAN DIEGO STATE: CA ZIP: 92121 FORMER COMPANY: FORMER CONFORMED NAME: Security With Advanced Technology, Inc. DATE OF NAME CHANGE: 20061010 FORMER COMPANY: FORMER CONFORMED NAME: A4S SECURITY, INC. DATE OF NAME CHANGE: 20050602 FORMER COMPANY: FORMER CONFORMED NAME: A4S TECHNOLOGIES INC DATE OF NAME CHANGE: 20030128 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PUSEY GREGORY CENTRAL INDEX KEY: 0001008071 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-32566 FILM NUMBER: 081098289 BUSINESS ADDRESS: STREET 1: 1722 BUFFEHR CREEK RD CITY: VAIL STATE: CO ZIP: 81657 BUSINESS PHONE: 9704792800 MAIL ADDRESS: STREET 1: 106 S UNIVERSITY BLVD., #14 CITY: DENVER STATE: CO ZIP: 80209 4 1 edgar123.xml FORM 4 X0303 4 2008-09-29 0 0001216199 PepperBall Technologies, Inc. PBAL 0001008071 PUSEY GREGORY 106 S. UNIVERSITY BOULEVARD #14 DENVER CO 80209 1 1 0 0 Chairman Common Stock 5504 I By Cambridge Holdings Ltd Common Stock 67244 I By spouse Common Stock 2008-09-29 4 P 0 200 .59 A 237143 D Common Stock 2008-09-29 4 P 0 10550 .7 A 247693 D Option (Right to Buy) 9.86 2007-05-05 2016-05-04 Common Stock 10000 10000 D Option (Right to Buy) 7.00 2005-10-29 2014-10-28 Common Stock 27174 27174 D Option (Right to Buy) 7.00 2005-03-02 2015-03-01 Common Stock 10870 10870 D Warrant (Right to Buy) 18.00 2005-08-25 2010-07-18 Common Stock 500 1000 D Warrant (Right to Buy) 18.00 2005-08-25 2010-07-18 Common Stock 2500 5000 I By Cambridge Holdings Ltd Warrant (Right to Buy) 9.5 2007-04-01 2010-10-01 Common Stock 6000 12000 D Series B Convertible Preferred Stock 0 2008-09-17 Common Stock 15000 3000 D Warrant (Right to Buy) 18.00 2007-04-01 2010-07-18 Common Stock 3500 7000 I By spouse Warrant (Right to Buy) 9.50 2007-04-01 2010-10-01 Common Stock 7000 14000 I By spouse Series B Convertible Preferred Stock 0 2008-09-17 Common Stock 5250 1050 I By spouse Option (Right to Buy) 2.42 2009-01-16 2018-01-15 Common Stock 25000 25000 D The Reporting Person disclaims beneficial ownership of these securities, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of the securities for purposes of Section 16 or for any other purpose. Includes 2,500 shares of Common Stock issuable upon exercise of warrants, whether or not presently exercisable. Reporting Person is President, director and principal shareholder of Cambridge Holdings Ltd. Includes (a) 6,488 shares of Common Stock held by Gregory Pusey IRA, (b) 6,500 shares of Common Stock issuable upon exercise of warrants, whether or not presently exercisable, held by Gregory Pusey IRA, (c) 73,044 shares of Common Stock underlying options to purchase Common Stock, whether or not presently exercisable, and (d) 15,000 shares of Common Stock issuable upon conversion of shares of Series B Convertible Preferred Stock, whether or not presently convertible. Includes (a) 14,630 shares of Common Stock held by Reporting Person's spouse as custodian for child, (b) 4,380 shares of Common Stock held by Jill Pusey, IRA, the investment retirement account of the Reporting Person's spouse, (c) 10,500 shares of Common Stock issuable upon exercise of warrants, whether or not presently exercisable, and (d) 5,250 shares of Common Stock issuable upon conversion of Series B Convertible Preferred Stock, whether or not presently convertible, held by Reporting Person's spouse as custodian for child. Does not include 750 shares of the issuer's Common Stock held jointly by the Reporting Person and the Reporting Person's spouse and reported elsewhere in this Form 4. Option vests annually in three equal annual installments, beginning on this date. Option held by Gregory Pusey IRA. Held by the Reporting Person's spouse as custodian for the Reporting Person's child. No expiration date. Each share of the Series B Convertible Preferred Stock is for no further consideration, convertible into 5 shares of the issuer's Common Stock on this date upon, which is the date the issuer's shareholders approved the conversion of the Series B Convertible Preferred Stock. Pursuant to a reverse split, effective September 29, 2008, every two issued and outstanding shares of the issuer's Common Stock were exchanged for one post-reverse split share of the issuer's Common Stock. The number of shares reported in this column reflects a 50% reduction in ownership resulting from the reverse split. Represents post-reverse split shares. Includes, (a) 9,800 purchased by Gregory Pusey IRA and (b) 750 shares purchased jointly by the Reporting Person and the Reporting Person's spouse. Includes (a) 16,288 shares of Common Stock held by Gregory Pusey IRA, (b) 6,500 shares of Common Stock issuable upon exercise of warrants, whether or not presently exercisable, held by Gregory Pusey IRA, (c) 73,044 shares of Common Stock underlying options to purchase Common Stock, whether or not presently exercisable, and (d) 15,000 shares of Common Stock issuable upon conversion of shares of Series B Convertible Preferred Stock, whether or not presently convertible, and (f) 750 shares held jointly by Reporting Person and Reporting Person's spouse. This derivative security was previously reported as exercisable for twice as many shares, but is adjusted in this Form 4 to reflect the number of shares issuable upon exercise or conversion, as applicable, following the issuer's reverse stock split that occurred on September 29, 2008. This derivative security was previously reported as having an exercise price of half this amount, but is adjusted in this Form 4 to reflect the exercise price following the issuer's reverse stock split that occurred on September 29, 2008. Adjusted to reflect the issuer's reverse stock split that occurred on September 29, 2008. /s/ Jill Pusey as attorney-in-fact 2008-09-29 -----END PRIVACY-ENHANCED MESSAGE-----