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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 | ||||||||
Series A Convertible Preferred | (1) | 11/21/2007 | C | 18,802 | (1) | (1) | Common Stock | 13,618 | $ 0 | 0 | D | ||||
Series C-2 Convertible Preferred | (1) | 11/21/2007 | C | 189,953 | (1) | (1) | Common Stock | 26,345 | $ 0 | 0 | D | ||||
Series D-2 Convertible Preferred | (1) | 11/21/2007 | C | 60,153 | (1) | (1) | Common Stock | 9,438 | $ 0 | 0 | D | ||||
Series E Convertible Preferred | (1) | 11/21/2007 | C | 130,285 | (1) | (1) | Common Stock | 11,766 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MIKOLAJCZYK MICHAEL E C/O RUBICON TECHNOLOGY INC. 9931 FRANKLIN AVENUE FRANKLIN PARK, IL 60131 |
X |
/s/ Scott Glickson, attorney-in-fact | 11/26/2007 | |
**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 preferred stock is immediately convertible. Each share of preferred stock converted automatically into common stock upon the closing of the issuer's initial public offering according to the following ratios: each Series A Convertible Preferred Share on a one-to-0.5536 ratio, each Series C-2 Convertible Preferred Share on a one-to-0.1009 ratio, each Series D-2 Convertible Preferred Share on a one-to-0.1256 ratio, and each Series E Convertible Preferred on a one-to-0.0769 ratio. Amounts shown include shares of common stock issuable upon such conversion in exchange for accrued dividends on the preferred stock at the following rates: Series A at $9.6083 per share, Series C-2 at $7.5595 per share, Series D-2 at $6.6690 per share, and Series E at $3.6478 per share. |
(2) | Consists of shares of Common Stock held by the Reporting Person's son, Mark Mikolajczyk. The Reporting Person disclaims beneficial ownership of these shares. |