EXHIBITS
10.1
REG D Closing August 15, 2005-- Private Placement Stock Purchase Agreement
between accredited investors and Registrant, dated as of January 18, 2005
closing by its terms August 15, 2005 SEC 1972 Potential persons who are to
respond to the collection of information contained in this form (6-02) are not
required to respond unless the form displays a currently valid OMB control
number.
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ATTENTION
Failure to file notice in the appropriate states will not result in a loss of
the federal exemption. Conversely, failure to file the appropriate federal
notice will not result in a loss of an available state exemption state exemption
unless such exemption is predicated on the filing of a federal notice.
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM D
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SEC USE ONLY
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Prefix | | Serial
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DATE RECEIVED
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NOTICE OF SALE OF SECURITIES
PURSUANT TO REGULATION D,
SECTION 4(6), AND/OR
UNIFORM LIMITED OFFERING EXEMPTION
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Name of Offering ([ ] check if this is an amendment and name has changed, and
indicate change.)
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Filing Under (Check box(es) that apply) [_] Rule 504 [_] Rule 505 [X] Rule 506
[_] Section 4(6) [_] ULOE :
Type of Filing: [X] New Filing [_] Amendment
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A. BASIC IDENTIFICATION DATA
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1. Enter the information requested about the issuer
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Name of Issuer ([ ] check if this is an amendment and name has changed, and
indiciate change.) Mediscience Technology Corp.
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Address of Executive Offices 0000 Xxxxxxxxx Xxx, Xxxxxx Xxxx, XX 00000 Telephone
Number (Including Area Code) (000) 000-0000 and (000) 000-0000
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Address of Principal Business Operations 0000 Xxxxxxxxx Xxx, Xxxxxx Xxxx, XX
0000 Telephone Number (Including Area Code) (000) 000-0000 and (000- 000-0000
different from Executive Offices)
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Brief Description of Business: Develops (and plans to market after FDA approval)
rapid, non-invasive, point-of-care photonic imaging systems used in screening
for and detecting precancerous and cancerous tissue and physiological changes in
gynecological and breast tissue.
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Type of Business Organization
[X] corporation [_] limited partnership, already formed
[_] business trust [_] limited partnership, to be formed
[_] other (please specify):
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Month Year
Actual or Estimated Date of Incorporation or Organization: [0]3] [7]1]
[X] Actual [_] Estimated
Jurisdiction of Incorporation or Organization: (Enter two-letter U.S. Postal
Service abbreviation for State: CN for Canada;FN for other foreign jurisdiction)
[ N ] [ J ]
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GENERAL INSTRUCTIONS
Federal:
Who Must File: All issuers making an offering of securities in reliance on an
exemption under Regulation D or Section 4(6), 17 CFR 230.501 et seq. or 15
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U.S.C. 77d(6).
When to File: A notice must be filed no later than 15 days after the first sale
of securities in the offering. A notice is deemed filed with the U.S. Securities
and Exchange Commission (SEC) on the earlier of the date it is received by the
SEC at the address given below or, if received at that address after the date on
which it is due, on the date it was mailed by United States registered or
certified mail to that address.
Where to File: U.S. Securities and Exchange Commission, 000 Xxxxx Xxxxxx, X.X.,
Xxxxxxxxxx, X.X. 00000.
Copies Required: Five (5) copies of this notice must be filed with the SEC, one
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of which must be manually signed. Any copies not manually signed must be
photocopies of manually signed copy or bear typed or printed signatures.
Information Required: A new filing must contain all information requested.
Amendments need only report the name of the issuer and offering, any changes
thereto, the information requested in Part C, and any material changes from the
information previously supplied in Parts A and B. Part E and the Appendix need
not be filed with the SEC.
Filing Fee: There is no federal filing fee.
State:
This notice shall be used to indicate reliance on the Uniform Limited Offering
Exemption (ULOE) for sales of securities in those states that have adopted ULOE
and that have adopted this form. Issuers relying on ULOE must file a separate
notice with the Securities Administrator in each state where sales are to be, or
have been made. If a state requires the payment of a fee as a precondition to
the claim for the exemption, a fee in the proper amount shall accompany this
form. This notice shall be filed in the appropriate states in accordance with
state law. The Appendix in the notice constitutes a part of this notice and must
be completed.
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A. BASIC IDENTIFICATION DATA
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2. Enter the information requested for the following:
o Each promoter of the issuer, if the issuer has been organized within
the past five years;
o Each beneficial owner having the power to vote or dispose, or direct
the vote or disposition of, 10% or more of a class of equity
securities of the issuer;
o Each executive officer and director of corporate issuers and of
corporate general and managing partners of partnership issuers; and
o Each general and managing partner of partnership issuers.
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Check Box(es) that [_] Promoter [X] Beneficial [X] Executive [X] Director
Apply: Owner Officer
[_] General and/or
Managing Partner
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Full Name (Last name first, if individual) Xxxxxxxxx, Xxxxx
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Business or Residence Address (Number and Street, City, State, Zip Code)
0000 Xxxxxxxxx Xxx, Xxxxxx Xxxx, XX 0000
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Check Box(es) that [_] Promoter [_] Beneficial [_] Executive [X] Director
Apply: Owner Officer
[_] General and/or
Managing Partner
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Full Name (Last name first, if individual) Xxxxxxx, Xxxx X.
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Business or Residence Address (Number and Street, City, State, Zip Code)
c/o Pepco Mfg. Co., 000 000 Xxxx Xxxxxxxxx Xxx, Xxxxxxxxxx, XX 00000
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Check Box(es) that [_] Promoter [_] Beneficial [_] Executive [X] Director
Apply: Owner Officer
[_] General and/or
Managing Partner
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Full Name (Last name first, if individual) Xxxxxxxxx, Xxxxxxx X.
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Business or Residence Address (Number and Street, City, State, Zip Code)
P.O. Box 607, Xxxxxx Lake, NY 2986
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Check Box(es) that [_] Promoter [_] Beneficial [_] Executive [X] Director
Apply: Owner Officer
[_] General and/or
Managing Partner
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Full Name (Last name first, if individual) Xxxxxxxx, Xxxxxxx
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Business or Residence Address (Number and Street, City, State, Zip Code)
00 Xxxxx Xxxxxxx, Xxxx Xxxxxxxxxxx, XX 00000
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Check Box(es) that [_] Promoter [_] Beneficial [_] Executive [X] Director
Apply: Owner Officer
[_] General and/or
Managing Partner
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Full Name (Last name first, if individual) Xxxxxxxxx, Xxxxxx
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Business or Residence Address (Number and Street, City, State, Zip Code)
604 overlook drive, 0 Xxxxxx Xxxxx, Xxxxx, Xxx Xxxxx XX, 00000
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Check Box(es) that [_] Promoter [_] Beneficial [_] Executive [X] Director
Apply: Owner Officer
[_] General and/or
Managing Partner
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Full Name (Last name first, if individual) Xxxxxx, Xxxx
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Business or Residence Address (Number and Street, City, State, Zip Code)
000 Xxxxxxxx Xxxxx XX Xxx 000, Xxxxx Xxxxx XX 00000
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Check Box(es) that [_] Promoter [_] Beneficial [X] Executive [X] Director
Apply: Owner Officer
[_] General and/or
Managing Partner
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Full Name (Last name first, if individual) Xxxxxxxxx, Xxxxxxx
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Business or Residence Address (Number and Street, City, State, Zip Code)
000 Xxxxx Xxxxxxxx Xxxxxxxx, Xxxxxx Xxx Xxxxxx, 00000
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(Use blank sheet, or copy and use additional copies of this
sheet, as necessary.)
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B. INFORMATION ABOUT OFFERING
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Yes No
1. Has the issuer sold, or does the issuer intend to sell,
to non-accredited investors in this offering?................ [_] [X]
Answer also in Appendix, Column 2, if filing under ULOE.
2. What is the minimum investment that will be accepted from
any individual?............................................. $25,000
Yes No
3. Does the offering permit joint ownership of a single
unit?....................................................... [_] [X]
4. Enter the information requested for each person who has been or will be paid
or given, directly or indirectly, any commission or similar remuneration for
solicitation of purchasers in connection with sales of securities in the
offering. If a person to be listed is an associated person or agent of a broker
or dealer registered with the SEC and/or with a state or states, list the name
of the broker or dealer. If more than five (5) persons to be listed are
associated persons of such a broker or dealer, you may set forth the information
for that broker or dealer only.
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Full Name (Last name first, if individual) None/not applicable
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Business or Residence Address (Number and Street, City, State, Zip Code)
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Name of Associated Broker or Dealer
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States in Which Person Listed Has Solicited or Intends to Solicit Purchasers
(Check "All States" or check individual States) .................. [_] All States
[AL] [AK] [AZ] [AR] [CA] [CO] [CT] [DE] [DC] [FL] [GA] [HI] [ID]
[IL] [IN] [IA] [KS] [KY] [LA] [ME] [MD] [MA] [MI] [MN] [MS] [MO]
[MT] [NE] [NV] [NH] [NJ] [NM] [NY] [NC] [ND] [OH] [OK] [OR] [PA]
[RI] [SC] [SD] [TN] [TX] [UT] [VT] [VA] [WA] [WV] [WI] [WY] [PR]
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Full Name (Last name first, if individual)
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Business or Residence Address (Number and Street, City, State, Zip Code)
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Name of Associated Broker or Dealer
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States in Which Person Listed Has Solicited or Intends to Solicit Purchasers
(Check "All States" or check individual States) .................. [_] All States
[AL] [AK] [AZ] [AR] [CA] [CO] [CT] [DE] [DC] [FL] [GA] [HI] [ID]
[IL] [IN] [IA] [KS] [KY] [LA] [ME] [MD] [MA] [MI] [MN] [MS] [MO]
[MT] [NE] [NV] [NH] [NJ] [NM] [NY] [NC] [ND] [OH] [OK] [OR] [PA]
[RI] [SC] [SD] [TN] [TX] [UT] [VT] [VA] [WA] [WV] [WI] [WY] [PR]
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Full Name (Last name first, if individual)
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Business or Residence Address (Number and Street, City, State, Zip Code)
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Name of Associated Broker or Dealer
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States in Which Person Listed Has Solicited or Intends to Solicit Purchasers
(Check "All States" or check individual States) .................. [_] All States
[AL] [AK] [AZ] [AR] [CA] [CO] [CT] [DE] [DC] [FL] [GA] [HI] [ID]
[IL] [IN] [IA] [KS] [KY] [LA] [ME] [MD] [MA] [MI] [MN] [MS] [MO]
[MT] [NE] [NV] [NH] [NJ] [NM] [NY] [NC] [ND] [OH] [OK] [OR] [PA]
[RI] [SC] [SD] [TN] [TX] [UT] [VT] [VA] [WA] [WV] [WI] [WY] [PR]
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(Use blank sheet, or copy and use additional copies
of this sheet, as necessary.)
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C. OFFERING PRICE, NUMBER OF INVESTORS, EXPENSES AND USE OF PROCEEDS
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1. Enter the aggregate offering price of securities included in this offering
and the total amount already sold. Enter "0" if answer is "none" or "zero." If
the transaction is an exchange offering, check this box [_] and indicate in
the columns below the amounts of the securities offered for exchange and already
exchanged.
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Aggregate Amount Already
Type of Security Offering Price Sold
Debt None......................................... $____________ $____________
Equity Convertible Preferred Stock................ $ 4,000,000 $ 1,525,000
[_] Common [X] Preferred
Convertible Securities (including warrants)....... $____________ $____________
Partnership Interests............................. $____________ $____________
Other (Specify____________________________________)$____________ $____________
Total..................................... $ 4,000,000 $ 1,525,000
Answer also in Appendix, Column 3, if filing under ULOE.
2. Enter the number of accredited and non-accredited investors who have
purchased securities in this offering and the aggregate dollar amounts of their
purchases. For offerings under Rule 504, indicate the number of persons who have
purchased securities and the aggregate dollar amount of their purchases on the
total lines. Enter "0" if answer is "none" or "zero."
Aggregate
Number Dollar Amount
Investors of Purchases
Accredited Investors ................................ 30 $1,525,000
Non-accredited Investors ............................ 0 $ 0
Total (for filings under Rule 504 only) ........... __________ $ ________
Answer also in Appendix, Column 4, if filing under ULOE
3. If this filing is for an offering under Rule 504 or 505, enter the
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information requested for all securities sold by the issuer, to date, in
offerings of the types indicated, the twelve (12) months prior to the first sale
of securities in this offering. Classify securities by type listed in Part
C-Question 1.
Type of Security Dollar Amount
Type of offering Sold
Rule 505 ...................................... ______________ $____________
Regulation A .................................. ______________ $____________
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Rule 504 ...................................... ______________ $____________
Total ....................................... ______________ $____________
4. a. Furnish a statement of all expenses in connection with the issuance and
distribution of the securities in this offering. Exclude amounts relating solely
to organization expenses of the issuer. The information may be given as subject
to future contingencies. If the amount of an expenditure is not known, furnish
an estimate and check the box to the left of the estimate.
Transfer Agent's Fees .............................. [_] $ 2,000
Printing and Engraving Costs ....................... [_] $ 1,000
Legal Fees ......................................... [_] $70,000
Accounting Fees .................................... [_] $ 2,000
Engineering Fees ................................... [_] $____________
Sales Commissions (specify finders' fees separately) [_] $____________
Other Expenses (identify) .......................... [_] $____________
Total .......................................... [_] $ ?
b. Enter the difference between the aggregate offering price given in response
to Part C - Question 1 and total expenses furnished in response to Part C -
Question 4.a. This difference is the "adjusted gross proceeds
to the issuer." ............ $ 1,400,000
5. Indicate below the amount of the adjusted gross proceeds to the issuer used
or proposed to be used for each of the purposes shown. If the amount for any
purpose is not known, furnish an estimate and check the box to the left of the
estimate. The total of the payments listed must equal the adjusted gross
proceeds to the issuer set forth in response to Part C - Question 4.b above.
Payments to
Officers,
DO OVER Directors, & Payments To
Affiliates Others
Salaries and fees ............................................ [X]$ 250,000 [ ]$_________
Purchase of real estate ...................................... [ ]$_________ [ ]$_________
Purchase, rental or leasing and installation of machinery
and equipment .............................................. [ ]$_________ [ ]$_________
Construction or leasing of plant buildings and facilities .... [ ]$_________ [ ]$_________
Acquisition of other businesses (including the value of
securities involved in this offering that may be used in
exchange for the assets or securities of another issuer ..... [ ]$_________ [ ]$_________
pursuant to a merger)
Repayment of indebtedness .................................... [ ]$_________ [ ]$_________
Working capital .............................................. [ ]$_________ [X]$ 500,000
Other (specify):Clinical development of PhotonX(TM) (cervical) [ ]$_________ [X]$ 200,000
PhotonX(TM) (cervical and other) prototypes .................. [X] $ 200,000
Regulatory, medical and scientific affairs ................... [ ]$_________ [X]$ 200,000
Market research: The adoption equation ....................... [X] $ 50,000
Column Totals ................................................ [X]$ 250,000 [X]$1,200,000
Total Payments Listed (column totals added) .................. [X] $ 1400,000
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D. FEDERAL SIGNATURE
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The issuer has duly caused this notice to be signed by the undersigned duly
authorized person. If this notice is filed under Rule 505, the following
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signature constitutes an undertaking by the issuer to furnish to the U.S.
Securities and Exchange Commission, upon written request of its staff, the
information furnished by the issuer to any non-accredited investor pursuant to
paragraph (b)(2) of Rule 502.
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Issuer (Print or Type) Signature Date
Mediscience Technology Corp. Xxxxx Xxxxxxxxx August 16, 2005
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Name of Signer (Print or Type) Title of Signer (Print or Type)
Xxxxx Xxxxxxxxx Esquire Chief Executive Officer and Independent Counsel
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ATTENTION
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Intentional misstatements or omissions of fact constitute federal criminal
violations. (See 18 U.S.C. 1001.)
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E. STATE SIGNATURE
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Yes No
1. Is any party described in 17 CFR 230.262 presently subject
to any of the disqualification provisions of such rule?............... [_] [_]
See Appendix, Column 5, for state response.
2. The undersigned issuer hereby undertakes to furnish to any state
administrator of any state in which this notice is filed, a notice on Form D (17
CFR 239,500) at such times as required by state law.
3. The undersigned issuer hereby undertakes to furnish to the state
administrators, upon written request, information furnished by the issuer to
offerees.
4. The undersigned issuer represents that the issuer is familiar with the
conditions that must be satisfied to be entitled to the Uniform limited Offering
Exemption (ULOE) of the state in which this notice is filed and understands that
the issuer claiming the availability of this exemption has the burden of
establishing that these conditions have been satisfied.
The issuer has read this notification and knows the contents to be true and has
duly caused this notice to be signed on its behalf by the undersigned duly
authorized person.
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Issuer (Print or Type) Signature Date
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Name of Signer (Print or Type) Title (Print or Type)
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Instruction:
Print the name and title of the signing representative under his signature for
the state portion of this form. One copy of every notice on Form D must be
manually signed. Any copies not manually signed must be photocopies of the
manually signed copy or bear typed or printed signatures.
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APPENDIX
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1 2 3 4 5
Disqualification
Type of security under State ULOE
Intend to sell and aggregate (if yes, attach
to non-accredited offering price Type of investor and explanation of
investors in State offered in state amount purchased in State waiver granted)
(Part B-Item 1) (Part C-Item 1) (Part C-Item 2) (Part E-Item 1)
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Number of Number of
Accredited Non-Accredited
State Yes No Investors Amount Investors Amount Yes No
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AL X
AK X
AZ X
AR X
CA X
CO X
CT X
DE X
DC X
FL X 8 $650,000 X
GA X
HI X
ID X
IL X
IN X
IA X
KS X
KY X
LA X
ME X
MD X
MA X
MI X
MN X
MS X
MO X
MT X
NE X
NV X
NH X
NJ X 2 $100,000 X
NM X
NY X 20 $775,000 X
NC X
ND X
OH X
OK X
OR X
PA X
RI X
SC X
SD X
TN X
TX X
UT X
VT X
VA X
WA X
WV X
WI X
WY X
PR X
xxxx://xxx.xxx.xxx/xxxxxxxxx/xxxxxxx/xxxxx/xxxxx.xxx
Last update: 06/06/2002
