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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 | ||||||||
Stock Option (right to buy) | $ 0.8 | 11/06/2007 | D | 145,000 | (2) | 06/05/2012 | Common Stock | 145,000 | (2) | 0 | D | ||||
Stock Option (right to buy) | $ 0.8 | 11/06/2007 | D | 24,125 | (2) | 07/11/2013 | Common Stock | 24,125 | (2) | 0 | D | ||||
Stock Option (right to buy) | $ 0.8 | 11/06/2007 | D | 113,750 | (2) | 02/17/2015 | Common Stock | 113,750 | (2) | 0 | D | ||||
Stock Option (right to buy) | $ 6.23 | 11/06/2007 | D | 40,000 | (2) | 02/06/2016 | Common Stock | 40,000 | (2) | 0 | D | ||||
Stock Option (right to buy) | $ 8.6 | 11/06/2007 | D | 46,630 | (2) | 05/24/2017 | Common Stock | 46,630 | (2) | 0 | D | ||||
Stock Option (right to buy) | $ 8.6 | 11/06/2007 | D | 28,370 | (2) | 05/24/2017 | Common Stock | 28,370 | (2) | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Merselis James D C/O HEMOSENSE, INC. 651 RIVER OAKS PKWY SAN JOSE, CA 95134 |
X | President, CEO |
/s/ JAMES D. MERSELIS | 11/06/2007 | |
**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) | Disposed of pursuant to merger agreement between issuer and Inverness Medical Innovations, Inc. ("Inverness") in exchange for shares of Inverness common stock on the effective date of the merger, November 6, 2007. The number of shares of common stock issued by Inverness is equal to the number of shares of HemoSense common stock held multiplied by the exchange ratio of 0.274192, with the resulting aggregated share number rounded down to the next whole share and fractional shares paid in cash. |
(2) | This option was assumed by Inverness in the merger and replaced with an option to purchase shares of Inverness common stock. The number of shares of Inverness common stock subject to the assumed option is calculated by multiplying the number of shares of HemoSense common stock subject to the options held by 0.274192, rounded down on a per-option basis to the next whole share. The exercise price of the assumed option is equal to the exercise price of the HemoSense option divided by 0.274192, rounded up to the next cent. |