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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 C Convertible Preferred Stock | (1) | 03/25/2008 | C | 857,143 | (1) | (1) | Common Stock | 428,571 | $ 0 | 0 | I | See Footnote (2) | |||
Series D Convertible Preferred Stock | (3) | 03/25/2008 | C | 199,732 | (3) | (3) | Common Stock | 99,866 | $ 0 | 0 | I | See Footnote (2) | |||
Mandatorily Convertible Preferred Stock | (4) | 03/25/2008 | C | 1,064 | (4) | (4) | Common Stock | 71,164 | $ 0 | 0 | I | See Footnote (2) | |||
Warrants to Purchase Series D-1 Convertible Preferred Stock | (6) | 03/25/2008 | C | 91,632 | (5) | (6) | Common Stock | 27,996 (7) | $ 0 | 0 | I | See Footnote (2) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
REIN HARRY T 105 ROWAYTON AVENUE ROWAYTON, CT 06853 |
X |
/s/ Doreen Roberts, Corporate Secretary, by power of attorney | 03/26/2008 | |
**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) | Each 2 shares of Series C Convertible Preferred Stock converted into 1 share of the Issuer's common stock upon the closing of the initial public offering for no additional consideration and had no expiration date. |
(2) | By Foundation Medical Partners LP. The voting and disposition of the shares held by Foundation Medical Partners LP is determined by Andrew D. Firlik, Lee R. Wrubel and Harry T. Rein as the general partners of Foundation Medical Partners LP. Messrs. Firlik, Wrubel and Rein have shared voting and investment power over the shares held by Foundation Medical Partners LP. Messrs. Firlik, Wrubel and Rein disclaim beneficial ownership of these shares except to the extent of their pecuniary interest therein. |
(3) | Each 2 shares of Series D Convertible Preferred Stock converted into 1 share of the Issuer's common stock upon the closing of the initial public offering for no additional consideration and had no expiration date. |
(4) | Each share of Mandatorily Convertible Preferred Stock converted into 66.88 shares of the Issuer's common stock upon the closing of the initial public offering for no additional consideration and had no expiration date. |
(5) | Warrants became exercisable on March 8, 2007. |
(6) | Warrants to purchase Series D-1 Convertible Preferred were automatically net exercised immediately prior to the closing of the Issuer's initial public offering. Each 2 shares of Series D-1 Convertible Preferred Stock converted into 1 share of the Issuer's common stock upon the closing of the initial public offering for no additional consideration and had no expiration date. |
(7) | Warrants were net exercised resulting in fewer shares being issued than if the exercise price had been paid for with cash. |
Remarks: Exhibit 24.1 Power of Attorney |