SEC Form 4
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*
WALPUCK JOHN

(Last) (First) (Middle)
7730 E BELLEVEIW AVE, SUITE A-306

(Street)
GREENWOOD VILLAGE CO 80111

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Disaboom, Inc. [ DSBO ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
CEO & CFO
3. Date of Earliest Transaction (Month/Day/Year)
07/02/2009
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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(3) 07/02/2009 P 36,422 A $0.05 536,422 D
Common Stock(3) 07/02/2009 P 24,693 A $0.07 561,115 D
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
Stock Option(1) $0.5 04/02/2007 01/01/2012 Common Stock 1,750,000 1,750,000 D
Stock Option(2) $0.2 11/04/2008 10/31/2008 Common Stock 2,500,000 2,500,000 D
Explanation of Responses:
1. These options were granted pursuant to Mr. Walpuck's employment agreement, dated April 2, 2007, and the Company's 2006 Stock Option Plan. The options vest as follows: (i) 250,000 options vested immediately; (ii) 250,000 options vest on September 1, 2007; (iii) 500,000 options vested on January 1, 2008; (iv) 500,000 options vested on January 1, 2009; and (v) 250,000 options vest upon a merger, acquisition, sale or change in control of the Company. This transaction was exempt from 16(b) reporting requirements pursuant to Rule 16b-3(d).
2. These options were granted pursuant to Mr. Walpuck's employment agreement, dated November 1, 2008, and the Company's 2006 Stock Option Plan and vest as follows: (i) 500,00 options vested immediately; and (ii) the remainder vesting quarterly on a pro-rata basis through October 31, 2011. This transaction was exempt from Section 16(b) pursuant to Rule 16b-3(d).
3. Shares received in lieu of a portion of the reporting person's salary for the months of April 2009 and May 2009. These shares were issued on July 2, 2009 and the number issued was determined based upon the amount of monthly cash salary foregone, the average share price of the Company's common stock during the applicable month, and a discount to compensate for the restricted nature of the stock grant.
/s/ John Walpuck 07/08/2009
** 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 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.