FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
MICRUS ENDOVASCULAR CORP [ MEND ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 06/21/2005 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 06/21/2005 | C | 532,268 | A | (1) | 532,268 | I | Polytechnos Medical Devices Ltd. | ||
Common Stock | 06/21/2005 | C | 291,404 | A | (1) | 291,404 | I | Polytechnos Venture Fund II LP | ||
Common Stock | 06/21/2005 | C | 72,586 | A | (1) | 72,586 | I | Polytechnos Venture Fund II GMBH & Co. KG | ||
Common Stock | 06/21/2005 | C | 2,329 | A | (1) | 2,329 | I | Polytechnos Partners & Team GMBH | ||
Common Stock | 06/21/2005 | C | 666 | A | (1) | 666 | I | Global Venture Advisors GMBH | ||
Common Stock | 06/21/2005 | X | 106 | A | (2) | 772 | I | Global Venture Advisors GMBH | ||
Common Stock | 06/21/2005 | X | 22,641 | A | (2) | 554,909 | I | Polytechnos Medical Devices Ltd. | ||
Common Stock | 06/21/2005 | X | 11,420 | A | (2) | 302,824 | I | Polytechnos Venture Fund II LP | ||
Common Stock | 06/21/2005 | X | 2,844 | A | (2) | 75,430 | I | Polytechnos Venture Fund II GMBH & Co. KG | ||
Common Stock | 06/21/2005 | X | 143 | A | (2) | 2,472 | I | Polytechnos Partners & Team GMBH |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series D Preferred Stock | (1) | 06/21/2005 | C | 532,268 | (1) | (3) | Common Stock | 532,268 | $0.00 | 0 | I | Polytechnos Medical Devices Ltd. | |||
Series D Preferred Stock | (1) | 06/21/2005 | C | 153,885 | (1) | (3) | Common Stock | 153,885 | $0.00 | 0 | I | Polytechnos Venture Fund II LP | |||
Series D Preferred Stock | (1) | 06/21/2005 | C | 38,332 | (1) | (3) | Common Stock | 38,332 | $0.00 | 0 | I | Polytechnos Venture Fund II GMBH & Co. KG | |||
Series D Preferred Stock | (1) | 06/21/2005 | C | 1,941 | (1) | (3) | Common Stock | 1,941 | $0.00 | 0 | I | Polytechnos Partners & Team GMBH | |||
Series D-3 Preferred Stock | (1) | 06/21/2005 | C | 666 | (1) | (3) | Common Stock | 666 | $0.00 | 0 | I | Global Venture Advisors GMBH | |||
Series D-3 Preferred Stock | (1) | 06/21/2005 | C | 30,776 | (1) | (3) | Common Stock | 30,776 | $0.00 | 0 | I | Polytechnos Venture Fund II LP | |||
Series D-3 Preferred Stock | (1) | 06/21/2005 | C | 7,666 | (1) | (3) | Common Stock | 7,666 | $0.00 | 0 | I | Polytechnos Venture Fund II GMBH & Co. KG | |||
Series D-3 Preferred Stock | (1) | 06/21/2005 | C | 388 | (1) | (3) | Common Stock | 388 | $0.00 | 0 | I | Polytechnos Partners & Team GMBH | |||
Series E Preferred Stock | (1) | 06/21/2005 | C | 106,743 | (1) | (3) | Common Stock | 106,743 | $0.00 | 0 | I | Polytechnos Venture Fund II LP | |||
Series E Preferred Stock | (1) | 06/21/2005 | C | 26,588 | (1) | (3) | Common Stock | 26,588 | $0.00 | 0 | I | Polytechnos Venture Fund II GMBH & Co. KG | |||
Common Stock Warrant(4) | $7.52(5) | 06/21/2005 | X | 333 | (6) | (7) | Common Stock | 333 | $0.00 | 0 | I | Global Venture Advisors GMBH | |||
Series D Preferred Warrant(8) | $7.52 | 06/21/2005 | C | 71,463 | (6) | (7) | Series D Preferred Stock | 71,463 | $0.00 | 0 | I | Polytechnos Medical Devices Ltd. | |||
Common Stock Warrant(8) | $7.52 | 06/21/2005 | C | 71,463 | (6) | (7) | Common Stock | 71,463 | $0.00 | 71,463 | I | Polytechnos Medical Devices Ltd. | |||
Common Stock Warrant(8) | $7.52(5) | 06/21/2005 | X | 71,463 | (6) | (7) | Common Stock | 71,463 | $0.00 | 0 | I | Polytechnos Medical Devices Ltd. | |||
Serries D Preferred Warrant(8) | $7.52 | 06/21/2005 | C | 20,660 | (6) | (7) | Series D Preferred Stock | 20,660 | $0.00 | 0 | I | Polytechnos Venture Fund II LP | |||
Common Stock Warrant(8) | $7.52 | 06/21/2005 | C | 20,660 | (6) | (7) | Common Stock | 20,660 | $0.00 | 20,660 | I | Polytechnos Venture Fund II LP | |||
Common Stock Warrant(8) | $7.52(5) | 06/21/2005 | X | 20,660 | (6) | (7) | Common Stock | 20,660 | $0.00 | 0 | I | Polytechnos Venture Fund II LP | |||
Common Stock Warrant(4) | $7.52(5) | 06/21/2005 | X | 15,388 | (6) | (7) | Common Stock | 15,388 | $0.00 | 0 | I | Polytechnos Venture Fund II LP | |||
Series D Preferred Warrant(8) | $7.52 | 06/21/2005 | C | 5,146 | (6) | (7) | Series D Preferred Stock | 5,146 | $0.00 | 0 | I | Polytechnos Venture Fund II GMBH & Co. KG | |||
Common Stock Warrant(8) | $7.52 | 06/21/2005 | C | 5,146 | (6) | (7) | Common Stock | 5,146 | $0.00 | 5,146 | I | Polytechnos Venture Fund II GMBH & Co. KG | |||
Common Stock Warrant(8) | $7.52(5) | 06/21/2005 | X | 5,146 | (6) | (7) | Common Stock | 5,146 | $0.00 | 0 | I | Polytechnos Venture Fund II GMBH & Co. KG | |||
Common Stock Warrant(4) | $7.52(5) | 06/21/2005 | X | 3,833 | (6) | (7) | Common Stock | 3,833 | $0.00 | 0 | I | Polytechnos Venture Fund II GMBH & Co. KG | |||
Series D Preferred Warrant(8) | $7.52 | 06/21/2005 | C | 260 | (6) | (7) | Series D Preferred Stock | 260 | $0.00 | 0 | I | Polytechnos Partners & Team GMBH | |||
Common Stock Warrant(8) | $7.52 | 06/21/2005 | C | 260 | (6) | (7) | Common Stock | 260 | $0.00 | 260 | I | Polytechnos Partners & Team GMBH | |||
Common Stock Warrant(8) | $7.52(5) | 06/21/2005 | X | 260 | (6) | (7) | Common Stock | 260 | $0.00 | 0 | I | Polytechnos Partners & Team GMBH | |||
Common Stock Warrant(4) | $7.52(5) | 06/21/2005 | X | 194 | (6) | (7) | Common Stock | 194 | $0.00 | 0 | I | Polytechnos Partners & Team GMBH |
Explanation of Responses: |
1. Converts on a 1 to 1 basis. |
2. The shares were acquired by the net exercise of warrants. |
3. N/A |
4. The Common Warrants were converted and exercised for Common Stock at the closing of the initial public offering. |
5. The warrants were net exercised. |
6. Immediately Exerciseable |
7. Five years from the date of issuance or at the close of initial public offering. |
8. The Series D Preferred Warrants were converted and exercised for Common Stock at the closing of the initial public offering. |
Remarks: |
/s/ Simon Waddington by Robert Stern, Attorney-in-Fact | 06/23/2005 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |