- Initial Statement of Beneficial Ownership (3)
21 December 2010 - 8:36AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
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3235-0104
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February 28, 2011
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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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1. Name and Address of Reporting Person
*
KANE MICHAEL J
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2. Date of Event Requiring Statement (MM/DD/YYYY)
8/23/2010
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3. Issuer Name
and
Ticker or Trading Symbol
Innolog Holdings Corp. [INHC]
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(Last)
(First)
(Middle)
4000 LEGATO ROAD, #830
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
___
X
___ 10% Owner
___
X
___ Officer (give title below)
_____ Other (specify below)
Secretary/Treasurer /
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(Street)
FAIRFAX, VA 22033
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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205527
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D
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Common Stock
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137018
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I
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See footnote
(1)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Series A Convertible Preferred Stock
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8/13/2010
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(3)
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Common Stock
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1102769
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$0.00
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D
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Series A Convertible Preferred Stock
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8/13/2010
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(3)
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Common Stock
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700000
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$0.00
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I
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See footnote
(1)
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Warrant to purchase Common Stock
(2)
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8/13/2010
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3/31/2016
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Common Stock
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220000
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$0.0227
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D
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Warrant to purchase Common Stock
(2)
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8/13/2010
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6/1/2015
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Common Stock
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1559495
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$0.50
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D
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Warrant to purchase Common Stock
(2)
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8/13/2010
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6/1/2015
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Common Stock
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700000
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$0.50
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I
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See footnote
(1)
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Explanation of Responses:
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(
1)
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These securities are owned by FIVEK Investments, LP. Mr. Kane is the general partner of this entitiy and has voting and
investment control over these securities.
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(
2)
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These derivative securities were granted by Innolog Holdings Corporation prior to a merger that was consummated with the
Issuer on August 13, 2010 and were immediately exercisable on the date of grant. These derivative securities were assumed
by the Issuer as part of the merger transaction.
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(
3)
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N/A
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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KANE MICHAEL J
4000 LEGATO ROAD, #830
FAIRFAX, VA 22033
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X
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X
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Secretary/Treasurer
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Signatures
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/s/ Michael Kane
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12/15/2010
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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