Filed
by the Registrant x
|
|
Filed
by a Party other than the Registrant o
|
|
Check
the appropriate box:
|
o Preliminary Proxy
Statement
|
|
o Confidential, for
Use of the Commission Only (as permitted by
Rule 14a-6(e)(2))
|
|
x Definitive Proxy
Statement
|
|
o Definitive
Additional Materials
|
|
o Soliciting
Material Pursuant to §240.14a-12
|
Payment of Filing Fee (Check the appropriate box): | |
x No fee
required.
|
|
o Fee computed on
table below per Exchange Act Rules 14a-6(i)(1) and
0-11.
|
1) Title
of each class of securities to which transaction
applies:
|
|
2) Aggregate
number of securities to which transaction applies:
|
|
3) Per
unit price or other underlying value of transaction computed pursuant to
Exchange Act Rule 0-11 (set forth the amount on which the filing fee
is calculated and state how it was determined):
|
|
4) Proposed
maximum aggregate value of transaction:
|
|
5) Total
fee paid:
|
|
o Fee paid
previously with preliminary materials.
|
|
o Check box if any
part of the fee is offset as provided by Exchange Act Rule 0-11(a)(2)
and identify the filing for which the offsetting fee was paid previously.
Identify the previous filing by registration statement number, or the Form
or Schedule and the date of its
filing.
|
1) Amount
Previously Paid:
|
|
2) Form,
Schedule or Registration Statement No.:
|
|
3) Filing
Party:
|
|
4) Date
Filed:
|
|
Name of Nominee
|
Age
|
Director Since
|
Principal Occupation
|
|||
Edward
J. Quilty
|
59
|
March,
1996
|
Chairman
of the Board, President and Chief Executive Officer of the
Company
|
|||
Srini
Conjeevaram (1)
|
51
|
May,
1998
|
Director,
Managing Director of SC Capital Management, LLC
|
|||
Stephen
T. Wills, CPA, MST (2)
(4)
|
53
|
May,
2000
|
Lead
Director, Executive Vice President — Operations and Chief
Financial Officer of Palatin Technologies, Inc.
|
|||
James
T. O’Brien (3)
(4)
|
71
|
May,
2001
|
Director,
Consultant to the pharmaceutical industry
|
|||
C.
Richard Stafford, Esq. (4)
(6)
|
74
|
May,
2002
|
Director,
Consultant to the pharmaceutical industry
|
|||
Richard
J. Keim (1)
(6)
|
74
|
May,
2002
|
Director,
Managing Director of Kensington Management Group, LLC
|
|||
Robert
G. Moussa (5)
(6)
|
63
|
May,
2005
|
Director,
President and Chief Executive Officer of Dilon Technologies,
Inc.
|
|||
Bruce
F. Wesson (1)
|
67
|
May,
2006
|
Vice
Lead Director, Managing Director of Galen
Management
|
|||
Brett
D. Hewlett
|
47
|
February,
2010
|
Chief
Executive Officer of Comvita
Limited
|
Name |
Fees
Earned or Paid in Cash |
Option
Awards |
Total
|
|||||||||
Edward
J. Quilty
|
—
|
— |
—
|
|||||||||
Stephen
T. Wills, CPA, MST
|
$ |
50,000
|
$ |
15,930
|
(1)
|
$ |
65,930
|
|||||
Srini
Conjeevaram
|
$ |
25,000
|
|
$ |
9,379
|
(2)
|
$ |
34,379
|
||||
James
T. O’Brien
|
$ |
25,000
|
$ |
9,379
|
(2)
|
$ |
34,379
|
|||||
Richard
J. Keim
|
$ |
25,000
|
$ |
9,379
|
(2)
|
$ |
34,379
|
|||||
C.
Richard Stafford, Esq.
|
$ |
25,000
|
$ |
9,379
|
(2)
|
$ |
34,379
|
|||||
Robert
G. Moussa
|
$ |
28,000
|
$ |
9,379
|
(2)
|
$ |
37,379
|
|||||
Bruce
F. Wesson
|
$ |
25,000
|
$ |
9,379
|
(2)
|
$ |
34,379
|
1. |
The
name and residential address of the proposed nominee and of each notifying
shareholder;
|
|
2. |
The
principal occupation of the proposed nominee;
|
|
|
3.
|
A
representation that the notifying shareholder intends to appear in person
or by proxy at the meeting to nominate the person specified in the
notice;
|
|
4.
|
The
total number of our shares owned by the notifying
shareholder;
|
|
5.
|
A
description of all arrangements or understandings between the notifying
shareholder and the proposed nominee and any other person or persons
pursuant to which the nomination is to be made by the notifying
shareholder;
|
|
6.
|
Any
other information regarding the nominee that would be required to be
included in a proxy statement filed with the SEC;
and
|
|
7.
|
The
consent of the nominee to serve as one of our directors, if
elected.
|
2009
|
2008
|
|||||||
Audit
fees
|
$ | 420,000 | $ | 415,000 | ||||
Audit
related fees
|
79,000 | 17,500 | ||||||
Totals
|
$ | 499,000 | $ | 432,500 |
Name
|
Age
|
Position with the Company
|
Executive
Officer
of the Company Since
|
|||
Edward
J. Quilty
|
59
|
Chairman
of the Board, President and Chief Executive Officer
|
May,
1996
|
|||
John
E. Yetter, CPA
|
57
|
Vice
President and Chief Financial Officer
|
August,
2000
|
|||
Robert
C. Cole
|
57
|
Executive
Vice President – Sales
|
January,
2003
|
|||
Frederic
Eigner
|
60
|
Executive
Vice President of Operations and General Manager, Derma Sciences Canada
Inc.
|
March,
2005
|
|||
Barry
J. Wolfenson
|
43
|
Executive
Vice President – Global Business Development and Marketing
|
March,
2006
|
Name
and
Principal
Position
|
Year
|
Salary
|
Bonus
|
Option
Awards |
All
Other Compensation
|
Total
|
||||||||||||||||||
Edward
J. Quilty
|
2009
|
$ |
357,000
|
—
|
$ |
59,250
|
$ |
12,095
|
(1)
|
$ |
428,345
|
|||||||||||||
Chairman
and Chief
|
2008
|
$ |
357,000
|
—
|
—
|
$ |
8,705
|
(2)
|
$ |
365,705
|
||||||||||||||
Executive
Officer
|
2007
|
$ |
340,000
|
$ |
120,000
|
$ |
291,000
|
$ |
11,495
|
(3)
|
$ |
762,495
|
||||||||||||
John
E. Yetter, CPA
|
2009
|
$ |
225,750
|
—
|
$ |
31,875
|
$ |
6,773
|
(4)
|
$ |
264,398
|
|||||||||||||
Vice
President and
|
2008
|
$ |
225,750
|
—
|
—
|
$ |
2,312
|
(4)
|
$ |
228,062
|
||||||||||||||
Chief
Financial Officer
|
2007
|
$ |
215,000
|
$ |
40,000
|
$ |
145,500
|
$ |
6,450
|
(4)
|
$ |
406,950
|
||||||||||||
Robert
C. Cole
|
2009
|
$ |
204,750
|
—
|
$ |
31,875
|
$ |
11,975
|
(5)
|
$ |
248,600
|
|||||||||||||
Executive
Vice
|
2008
|
$ |
204,750
|
—
|
—
|
$ |
9,555
|
(6)
|
$ |
214,305
|
||||||||||||||
President – Sales
|
2007
|
$ |
195,000
|
$ |
35,000
|
$ |
145,500
|
$ |
12,331
|
(7)
|
$ |
387,831
|
||||||||||||
Frederic
Eigner
|
2009
|
$ |
200,784
|
—
|
$ |
31,875
|
$ |
7,438
|
(8)
|
$ |
240,097
|
|||||||||||||
Executive
Vice President –
|
2008
|
$ |
214,802
|
—
|
—
|
$ |
7,459
|
(9)
|
$ |
222,261
|
||||||||||||||
Operations
and General Manager,
|
2007
|
$ |
203,221
|
$ |
40,000
|
$ |
145,500
|
$ |
7,010
|
(10)
|
$ |
395,731
|
||||||||||||
Derma
Sciences Canada Inc.
|
||||||||||||||||||||||||
Barry
J. Wolfenson
|
2009
|
$ |
178,500
|
—
|
$ |
31,875
|
$ |
5,355
|
(4)
|
$ |
215,730
|
|||||||||||||
Executive
Vice President –
|
2008
|
$ |
178,500
|
—
|
—
|
$ |
3,300
|
(4)
|
$ |
181,800
|
||||||||||||||
Global
Business Development and Marketing
|
2007
|
$ |
170,000
|
$ |
45,000
|
$ |
145,500
|
$ |
4,463
|
(4)
|
$ |
364,963
|
(1)
|
Consists of 401(k) matching contribution of $7,350 and disability insurance of $4,745. |
(2)
|
Consists of 401(k) matching
contribution of $3,960 and disability insurance of
$4,745.
|
(3)
|
Consists of 401(k) matching
contribution of $6,750 and disability insurance of
$4,745.
|
(4)
|
Consists of 401(k) matching
contribution.
|
(5)
|
Consists of 401(k) matching
contribution of $4,775 and car allowance of
$7,200.
|
(6)
|
Consists of 401(k) matching
contribution of $2,355 and car allowance of
$7,200.
|
(7)
|
Consists of 401(k) matching
contribution of $5,131 and car allowance of
$7,200.
|
(8)
|
Consists of salary deferral plan
matching contribution of $6,024 and disability insurance of
$1,414.
|
(9)
|
Consists of salary deferral plan
matching contribution of $6,247 and disability insurance of
$1,212.
|
(10)
|
Consists of salary deferral plan
matching contribution of $6,142 and disability insurance of
$868.
|
Option
Awards
|
||||||||||||||||
Name
|
Number
of
Securities
Underlying
Unexercised
Options
(Exercisable)
|
Number
of
Securities
Underlying
Unexercised
Options
(Unexercisable)
|
Option
Exercise
Price
|
Option
Expiration
Date
|
||||||||||||
Edward
J. Quilty
|
3,125
|
28,125
|
$ |
3.12
|
02/25/2019
|
|||||||||||
18,750
|
6,250
|
$ |
4.80
|
11/29/2017
|
||||||||||||
|
18,750
|
—
|
$ |
6.40
|
02/22/2017
|
|||||||||||
|
24,219
|
—
|
$ |
4.00
|
03/01/2015
|
|||||||||||
|
6,250
|
—
|
$ |
12.40
|
02/24/2014
|
|||||||||||
|
9,375
|
—
|
$ |
2.96
|
03/25/2013
|
|||||||||||
|
3,750
|
—
|
$ |
4.88
|
02/26/2012
|
|||||||||||
|
28,125
|
—
|
$ |
3.20
|
08/24/2011
|
|||||||||||
John
E. Yetter, CPA
|
1,563
|
14,062
|
$ |
3.12
|
02/25/2019
|
|||||||||||
9,375
|
3,125
|
$ |
4.80
|
11/29/2017
|
||||||||||||
|
9,375
|
—
|
$ |
6.40
|
02/22/2017
|
|||||||||||
|
14,532
|
—
|
$ |
4.00
|
03/01/2015
|
|||||||||||
|
3,125
|
—
|
$ |
12.40
|
02/24/2014
|
|||||||||||
|
5,000
|
—
|
$ |
2.96
|
03/25/2013
|
|||||||||||
|
2,500
|
—
|
$ |
4.88
|
02/26/2012
|
|||||||||||
|
12,500
|
—
|
$ |
3.20
|
08/24/2011
|
|||||||||||
|
7,500
|
—
|
$ |
6.00
|
08/28/2010
|
|||||||||||
Robert
C. Cole
|
1,563
|
14,062
|
$ |
3.12
|
02/25/2019
|
|||||||||||
9,375
|
3,125
|
$ |
4.80
|
11/29/2017
|
||||||||||||
|
9,375
|
—
|
$ |
6.40
|
02/22/2017
|
|||||||||||
|
14,532
|
—
|
$ |
4.00
|
03/01/2015
|
|||||||||||
|
3,125
|
—
|
$ |
12.40
|
02/24/2014
|
|||||||||||
|
21,875
|
—
|
$ |
4.00
|
11/26/2012
|
|||||||||||
Frederic
Eigner
|
1,563
|
14,062
|
$ |
3.12
|
02/25/2019
|
|||||||||||
9,375
|
3,125
|
$ |
4.80
|
11/29/2017
|
||||||||||||
|
9,375
|
—
|
$ |
6.40
|
02/22/2017
|
|||||||||||
|
15,235
|
—
|
$ |
4.00
|
03/01/2015
|
|||||||||||
|
3,750
|
—
|
$ |
12.40
|
02/24/2014
|
|||||||||||
|
2,500
|
—
|
$ |
13.60
|
07/07/2013
|
|||||||||||
|
6,250
|
—
|
$ |
4.56
|
09/15/2012
|
|||||||||||
Barry
J. Wolfenson
|
1,563
|
14,062
|
$ |
3.12
|
02/25/2019
|
|||||||||||
9,375
|
3,125
|
$ |
4.80
|
11/29/2017
|
||||||||||||
|
9,375
|
—
|
$ |
6.40
|
02/22/2017
|
|||||||||||
|
6,250
|
—
|
$ |
4.00
|
03/01/2015
|
|||||||||||
|
8,750
|
—
|
$ |
9.60
|
01/14/2014
|
Plan
Category
|
Number
of Securities
to
Be Issued Upon
Exercise
of
Outstanding
Options,
Warrants
and Rights
|
Weighted-Average
Exercise
Price of
Outstanding
Options,
Warrants
and Rights
|
Number
of Securities
Remaining
Available for
Future
Issuance Under
Equity
Compensation
Plans
(Excluding
Securities
Reflected in
Column
1)
|
|||||||||
Equity
Compensation Plans Approved by Shareholders
|
884,658
|
(1)
|
$ |
5.26
|
365,342
|
|||||||
Equity
Compensation Plans Not Approved by Shareholders
|
207,001
|
(2)
|
$ |
4.04
|
0
|
|||||||
Total
|
1,091,659
|
$ |
5.03
|
365,342
|
|
(1)
|
The
securities consist of Incentive Stock Options and Nonqualified Stock
Options granted to officers, directors, employees and consultants in 1997,
1998, 2003, 2004, 2005, 2006, 2007 and 2008 pursuant to our Stock Option
Plan. The per share exercise price of the options is in the range of $2.88
to $13.60. The shares of common stock underlying the options have been
registered under the Securities Act of
1933.
|
|
(2)
|
The
securities consist of Nonqualified Stock Options granted to our officers,
directors, employees and consultants during the period 1995 through 2002
and 2007. These options were effected pursuant to employment agreements or
stock option agreements recommended by the Compensation Committee of our
board of directors and approved by our board of directors. The per share
exercise price of the options is in the range of $3.20 to $6.00. The
shares of common stock underlying the options have been registered under
the Securities Act of 1933.
|
Name
and Address of Beneficial Owner (1)
|
Number
of
Shares
Beneficially
Owned
(20)
|
Percent
Beneficially
Owned
(20)
|
||||||
LB
I Group Inc. (2)
|
1,379,463
|
20.04
|
%
|
|||||
Comvita
Limited (3)
|
1,143,750
|
16.71
|
%
|
|||||
William
Harris Investors, Inc. (4)
|
713,548
|
10.65
|
%
|
|||||
Galen
III Partnerships (5)
|
574,257
|
8.38
|
%
|
|||||
Raging
Capital Management, LLC (6)
|
513,166
|
7.68
|
%
|
|||||
1837
Partners (7)
|
281,251
|
4.23
|
%
|
|||||
Kensington
Management Group, LLC (8)
|
200,533
|
3.04
|
%
|
|||||
Edward
J. Quilty (9)
|
184,555
|
2.76
|
%
|
|||||
Stephen
T. Wills, CPA, MST (10)
|
81,054
|
1.23
|
%
|
|||||
John
E. Yetter, CPA (11)
|
81,032
|
1.22
|
%
|
|||||
Robert
C. Cole (12)
|
76,657
|
1.16
|
%
|
|||||
James
T. O’Brien (13)
|
69,420
|
1.05
|
%
|
|||||
Srini
Conjeevaram (14)
|
62,345
|
0.94
|
%
|
|||||
C.
Richard Stafford, Esq. (15)
|
61,095
|
0.93
|
%
|
|||||
Frederic
Eigner (16)
|
58,610
|
0.89
|
%
|
|||||
Barry
J. Wolfenson (17)
|
55,513
|
0.84
|
%
|
|||||
Robert
G. Moussa (18)
|
34,220
|
0.52
|
%
|
|||||
All
directors and officers as a group (13 persons) (19)
|
2,683,041
|
33.61
|
%
|
(1)
|
Except
as otherwise noted, the address of each of the persons listed
is: 214 Carnegie Center, Suite 300, Princeton, New Jersey
08540.
|
(2)
|
LB
I Group Inc. can be reached at: 399 Park Avenue, 9 th
Floor, New York, New York 10022. Ownership consists of: 1,053,570 shares
of common stock, 200,893 Class J Warrants and 125,000 Class K
Warrants.
|
(3)
|
Comvita
Limited can be reached at: Wilson Road South, Paengaroa, Private Bag 1, Te
Puke, New Zealand. Ownership consists of: 858,333
shares of common stock, 52,083 Class H Warrants, 100,000 Class N Warrants
and 133,333 Class Q Warrants. Brett D. Hewlett, one of our
directors, is the Chief Executive Officer of Comvita New Zealand Limited,
an affiliate of Comvita Limited.
|
(4)
|
William
Harris Investors, Inc. can be reached at: 191 North Wacker
Drive, Suite 1500, Chicago, Illinois 60606. Includes shares
owned by William Harris Investors, Inc. and Panacea Fund,
LLC. Ownership consists of: 568,458 shares of common stock,
66,965 Class J Warrants and 78,125 Class K
Warrants.
|
(5)
|
The
Galen III Partnerships can be reached at: 680 Washington
Boulevard, 11th Floor, Stamford, Connecticut 06901. Includes
shares owned by Galen Partners III, L.P., Galen Partners International
III, L.P., Galen Employee Fund III, L.P. and Bruce F.
Wesson. Ownership consists of: 279,772 shares of
common stock, 15,627 shares of Class A Convertible Preferred Stock (“Class
A Preferred”), 52,085 shares of Class B Convertible Preferred Stock
(“Class B Preferred”), 77,384 shares of Class C Convertible Preferred
Stock (“Class C Preferred”), 133,919 shares of Class D Convertible
Preferred Stock (“Class D Preferred”) and exercisable options to purchase
15,470 shares of common stock. No additional options to
purchase common stock will become exercisable within 60 days of March 31,
2010. Bruce F. Wesson, one of our directors, is a General
Partner of the Galen III
Partnerships.
|
(6)
|
Raging
Capital Management, LLC can be reached at: 254 Witherspoon
Street, Princeton, New Jersey 08542. Includes shares owned by
Raging Capital Fund, LP and Raging Capital Fund (QP),
LP. Ownerships consists of: 384,500 shares of common
stock and 128,666 Class O Warrants.
|
(7)
|
1837
Partners can be reached at: 115 South LaSalle Street, 34 th
Floor, Chicago, IL 60603. Ownership consists
of: 187,500 shares of common stock and 93,751 Class K
Warrants.
|
(8)
|
Kensington
Management Group, LLC can be reached at: 767 Third Avenue, 16
th
Floor, New York, New York 10017. Includes shares owned by
Kensington Partners L.P., Kensington Partners II L.P., Bald Eagle Fund
Ltd. and Richard J. Keim. Ownership consists
of: 150,063 shares of common stock and exercisable options to
purchase 50,470 shares of common stock. No additional options
to purchase common stock will become exercisable within 60 days of March
31, 2010. Richard J. Keim, one of our directors, is a Managing
Director of Kensington Management Group, LLC.
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(9)
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Edward
J. Quilty’s ownership consists of: 53,336 shares of common
stock and exercisable options to purchase 131,219 shares of common
stock. No additional options to purchase common stock will
become exercisable within 60 days of March 31, 2010.
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(10)
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Stephen
T. Wills’ ownership consists of: 20,584 shares of common stock
and exercisable options to purchase 60,470 shares of common
stock. No additional options to purchase common stock will
become exercisable within 60 days of March 31, 2010.
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(11)
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John
E. Yetter’s ownership consists of: 5,000 shares of common stock
and exercisable options to purchase 76,032 shares of common
stock. No additional options to purchase common stock will
become exercisable within 60 days of March 31, 2010.
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(12)
|
Robert
C. Cole’s ownership consists of: 6,250 shares of common stock
and exercisable options to purchase 70,407 shares of common
stock. No additional options to purchase common stock will
become exercisable within 60 days of March 31, 2010.
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(13)
|
James
T. O’Brien’s ownership consists of: 15,825 shares of common
stock and exercisable options to purchase 53,595 shares of common
stock. No additional options to purchase common stock will
become exercisable within 60 days of March 31, 2010.
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(14)
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Srini
Conjeevaram can be reached at: SC Capital Management, LLC, P.O.
Box 323, Bronxville, New York 10708. Ownership consists
of: 3,125 shares of common stock and exercisable options to
purchase 59,220 shares of common stock. No additional options
to purchase common stock will become exercisable within 60 days of March
31, 2010.
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(15)
|
C.
Richard Stafford’s ownership consists of: 10,625 shares of
common stock and exercisable options to purchase 50,470 shares of common
stock. No additional options to purchase common stock will
become exercisable within 60 days of March 31, 2010.
|
(16)
|
Frederic
Eigner’s ownership consists of: exercisable options to purchase
58,610 shares of common stock. No additional options to
purchase common stock will become exercisable within 60 days of March 31,
2010.
|
(17)
|
Barry
J. Wolfenson’s ownership consists of: 9,638 shares of common
stock and exercisable options to purchase 45,875 shares of common
stock. No additional options to purchase common stock will
become exercisable within 60 days of March 31, 2010.
|
(18)
|
Robert
G. Moussa can be reached at: 2115 Imperial G.C. Boulevard,
Naples, Florida 34110. Ownership consists of: 10,000
shares of common stock and exercisable options to purchase 24,220 shares
of common stock. No additional options to purchase common stock
will become exercisable within 60 days of March 31,
2010.
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(19)
|
Ownership
consists of: common stock, Class A Preferred, Class B Preferred, Class C
Preferred, Class D Preferred and options currently exercisable and
exercisable within 60 days of March 31, 2010 to purchase shares of common
stock.
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(20)
|
The
number of shares beneficially owned and the percent beneficially owned by
each entity or individual are based upon 6,557,855 shares of common stock
outstanding and assume the exercise of all exercisable options (including
those that would be exercisable within 60 days of March 31, 2010), the
exercise of all warrants and the conversion into common stock of all
convertible preferred stock owned by such entity or
individual. The percent beneficially owned is a fraction the
numerator of which is the number of shares of common stock beneficially
owned by each entity or individual and the denominator of which is the
number of outstanding shares of common stock plus the number of shares of
common stock which would be issued upon exercise by the subject entity or
individual of its/his/her own options and
warrants and the conversion into common stock of its/his/her own convertible
preferred stock. This method of computing the percent
beneficially owned results in the aggregate ownership percentages of all
owners exceeding 100%.
|
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1.
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An
understanding of accounting principles generally accepted in the United
States and financial statements;
|
|
2.
|
The
ability to assess the general application of such principles in connection
with the accounting for estimates, accruals and
reserves;
|
|
3.
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Experience
preparing, auditing, analyzing and evaluating financial statements that
present a breadth and level of complexity of accounting issues that are
generally comparable to the breadth and complexity of issues that can
reasonably be expected to be raised by the Company’s financial statements,
together with experience actively supervising persons engaged in the
foregoing activities;
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4.
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An
understanding of internal controls and procedures for financial reporting;
and
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|
5. | An understanding of audit committee functions. |
By Order of the Board of Directors, | |
April 12, 2010 | Edward J. Quilty, Chairman |
1.
|
ELECTION
OF DIRECTORS:
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Nominees:
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01.
Edward J. Quilty
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02.
Srini Conjeevaram
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03.
Stephen T. Wills, CPA, MST
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04.
James T. O’Brien
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05.
C. Richard Stafford, Esq.
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06.
Richard J. Keim
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07.
Robert G. Moussa
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08.
Bruce F. Wesson.
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09.
Brett D. Hewlett
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2.
|
RATIFICATION
OF THE SELECTION OF ERNST & YOUNG LLP AS THE INDEPENDENT REGISTERED
PUBLIC ACCOUNTING FIRM FOR THE YEAR ENDING DECEMBER 31,
2010:
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FOR
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AGAINST
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ABSTAIN
|
3.
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DISCRETIONARY
AUTHORITY:
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FOR
|
AGAINST
|
ABSTAIN
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PLEASE
MARK, DATE AND SIGN THIS PROXY AND RETURN IT IN THE ENCLOSED
ENVELOPE. Please sign this proxy exactly as your name appears
in the address at the right. If shares are registered in more than one
name, all owners should sign. If you are signing in a fiduciary
or representative capacity, such as attorney-in-fact, executor,
administrator, trustee or guardian, please give full title and attach
evidence of authority. Corporations, please sign with full
corporate name by a duly authorized officer or
officers. If a partnership, please sign in partnership name by
an authorized person.
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