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 |
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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)
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2. Issuer Name and Ticker or Trading Symbol
COUPON EXPRESS, INC. [ CPXP ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 11/30/2012 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 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 |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 A Preferred Stock | (1) | 11/30/2012 | P | 4.1(1) | 11/30/2012 | (2) | Common Stock | 5,125,000(1) | (3) | 60.1(1) | I(4)(5) | See Footnotes(4)(5) | |||
Common Stock Warrants (right to buy) | $0.04 | 11/30/2012 | P | 5,125,000 | 11/30/2012 | 05/31/2017 | Common Stock | 5,125,000 | (3) | 25,125,000 | I(4)(5) | See Footnotes(4)(5) |
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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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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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Each share of Preferred Stock is convertible at any time, without payment of additional consideration, into 1,250,000 shares of the Issuer's Common Stock, subject to certain adjustments. |
2. The Preferred Stock has no expiration date. |
3. On November 30, 2012, NextLevel VIII, LLC ("NextLevel"), in connection with the exercise of NextLevel's right of first refusal made pursuant to the Cumulative Convertible Senior Note and Warrant Purchase Agreement dated as of May 31, 2012, purchased 4.1 shares of Series A Preferred Stock and warrants to purchase 5,125,000 shares of Common Stock for an aggregate purchase price of $102,500 (or 4.1 units consisting of 1 share of Series A Preferred Stock and 1,250,000 warrants to purchase common stock at a per unit price of $25,000). |
4. The reported securities are directly owned by NextLevel in NextLevel's name. All other Reporting Persons may be deemed to indirectly beneficially own the reported securities. Anita Kaufman and Joseph Heller are co-managers of NextLevel VIII, LLC, and may be deemed to share the power to vote and direct the disposition of, and to beneficially own, the reported securities. The Anita Kaufman Family Partnership LP and The Anita Kaufman Nextlevel VIII Trust FBO Joseph Heller are the two members of NextLevel VIII, LLC, and may be deemed to share the power to vote and direct the disposition of, and to beneficially own, the reported securities. AKFP-GP, LLC is the general partner of The Anita Kaufman Family Partnership LP, and may be deemed to share the power to vote and direct the disposition of, and to beneficially own, the reported securities. |
5. Joseph Heller and Lawrence Pecoraro are co-trustees of The Anita Kaufman Nextlevel VIII Trust FBO Joseph Heller, and may be deemed to share the power to vote and direct the disposition of, and to beneficially own, the reported securities. Anita Kaufman is also the managing member of AKFP-GP, LLC and may be deemed to share the power to vote and direct the disposition of, and to beneficially own, the reported securities. The Reporting Persons disclaim beneficial ownership of the reported securities except to the extent of such reporting person's pecuniary interest in the securities. |
/s/ Joseph Heller | 12/04/2012 | |
/s/ Anita Kaufman | 12/04/2012 | |
/s/ Joseph Heller, NEXTLEVEL VIIII, LLC | 12/04/2012 | |
/s/ Anita Kaufman, ANITA KAUFMAN FAMILY PARTNERSHIP LP | 12/04/2012 | |
/s/ Anita Kaufman, AKFP-GP, LLC | 12/04/2012 | |
/s/ Joseph Heller, ANITA KAUFMAN NEXTLEVEL VIII TRUST FBO JOSEPH HELLER | 12/04/2012 | |
/s/ Lawrence Pecoraro | 12/04/2012 | |
** 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. |