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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
PULEO MARC MD 1441 SW 29TH AVENUE POMPANO BEACH, FL 33069 |
X | |||
MARPUL INVESTMENTS LIMITED PARTNERSHIP 1441 S.W. 29TH AVE POMPANO BEACH, FL 33069 |
Partnership for Marpul Trust | |||
SOUTHPAC TRUST INTERNATIONAL, INC. / MARPUL TRUST TRUSTEE P.O. BOX 11 RAROTONGA, G1 00000 |
Trustee of Marpul Trust | |||
MARPUL TRUST / SOUTHPAC TRUST INTERNATIONAL, INC. P.O. BOX 11 RAROTONGA, G1 00000 |
Trust for Dr. Puleo |
/s/Marc A. Puleo, M.D. | 08/18/2005 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | The shares were transferred for no consideration from the Marpul Trust, a trust established by Dr. Puleo under an agreement dated September 3, 1999 and of which he is the beneficiary and Southpac Trust International, Inc. is the trustee, to Marpul Investments Limited Partnership, a Nevada limited partnership. Mr. Brian Mason, Managing Director of Southpac Trust International, Inc., a corporation established under the laws of the Cook Islands, holds voting and dispositive power over the securities owned by Marpul Trust. Dr. Puleo is the sole General Partner of Marpul Investments Limited Partnership and Marpul Trust is the sole limited partner. |
Remarks: Exhibit 99.1-Form 4 Joint Filer Information |