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) 11/20/2009 |
3. Issuer Name and Ticker or Trading Symbol
InfoLogix Inc [ IFLG ] |
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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, par value $0.00001 per share | 67,294,751(1) | I | By Hercules Technology I, LLC its wholly-owned subsidiary |
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 | ||||
Warrant (right to buy) | 11/20/2009 | 05/31/2014 | Common Stock par value $0.00001 per share | 250,000 | $0.0743 | D | |
Warrant (right to buy) | 11/20/2009(2) | 11/20/2014 | Common Stock par value $0.00001 per share | 16,823,688 | $0.0743 | I | By Hercules Technology I, LLC, its wholly-owned subsidiary |
Explanation of Responses: |
1. On November 20, 2009, Hercules Technology I, LLC, a limited liability company organized under the laws of Delaware, closed on its transaction to convert certain debt obligations of InfoLogix, Inc. (the "Company") into 67,294,751 newly issued shares of common stock, par value $0.00001 per share, of the Company ("Common Stock"). In connection with the closing of this transaction, the Company cancelled a warrant to 250,000 shares of Common Stock at a per share price of $0.42 per share held by Hercules Technology Growth Capital Inc. ("Hercules") and issued to Hercules a warrant to purchase the same amount of shares of Common Stock at a per share price of $.0743 per share. |
2. The warrant is immediately exercisable at such time when the Company amends its certificate of incorporation to increase the number of authorized shares of common stock or implements a reverse stock split that results in the Company having a sufficient amount of authorized shares to issue the shares underlying the warrant. |
/s/ H. Scott Harvey, Chief Legal Officer, on behalf of Hercules Technology Growth Capital, Inc. | 11/30/2009 | |
** 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. |