- Initial Statement of Beneficial Ownership (3)
14 October 2009 - 5:51AM
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
OMB Number:
3235-0104
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February 28, 2011
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hours per response...
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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
*
LORENZ MICHAEL J
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2. Date of Event Requiring Statement (MM/DD/YYYY)
9/30/2009
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3. Issuer Name
and
Ticker or Trading Symbol
Patient Portal Technologies, Inc. [PPRG]
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(Last)
(First)
(Middle)
5109 WATERFORD WOOD WAY
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
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X
___ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
President /
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(Street)
FAYETTEVILLE, NY 13066
(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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PPRG Common Stock
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388553
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D
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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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Restricted Stock Awards
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1/27/2014
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1/27/2014
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Stock Grant
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2000000
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$0
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I
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By Auspicium, LLC
(1)
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Incentive Stock Options
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11/30/2009
(2)
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5/18/2019
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Options
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2222220
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$0.18
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D
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Non Statutory Stock Options
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11/30/2009
(3)
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5/18/2019
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Options
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1777780
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$0.18
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D
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Explanation of Responses:
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(
1)
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Auspicium, LLC is owned 100% by Mike Lorenz
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(
2)
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Stock option vest as follows: 33.33% after 6 months, November 30,2009; 33.33% after 18 months, November 30, 2010 and 33.33% after 30 months, November 30, 2011.
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(
3)
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Stock option vest as follows: 33.33% after 6 months, November 30,2009; 33.33% after 18 months, November 30, 2010 and 33.33% after 30 months, November 30, 2011
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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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LORENZ MICHAEL J
5109 WATERFORD WOOD WAY
FAYETTEVILLE, NY 13066
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X
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President
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Signatures
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Michael Lorenz
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10/12/2009
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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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