SEC Form 4
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*
WEISEL THOMAS CAPITAL PARTNERS LLC

(Last) (First) (Middle)
One Montgomery Street, Suite 3700

(Street)
San Francisco CA 94104

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ACUSPHERE INC [ ACUS ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
10/14/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 10/14/2003 C 3,013,038 A $0(1) 3,013,038 I(1) See Footnote(1)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 F-2 Convertible Preferred Stock $0(2) 10/14/2003 C 2,493,423(2) 10/14/2003 10/14/2003(7) Common 512,717 $0(2) 0 I(2) See Footnote(2)
Series I-2 Convertible Preferred Stock $0(3) 10/14/2003 C 526,316(3) 10/14/2003 10/14/2003(7) Common 295,509 $0(3) 0 I(3) See Footnote(3)
Series J-2 Convertible Preferred Stock $0(4) 10/14/2003 C 3,546,099(4) 10/14/2003 10/14/2003(7) Common 591,017 $0(4) 0 I(4) See Footnote(4)
Series J-3 Convertible Preferred Stock $0(5) 10/14/2003 C 2,238,466(5) 10/14/2003 10/14/2003(7) Common 746,155 $0(5) 0 I(5) See Footnote(5)
10% Secured Convertible Promissory Note $0(6) 10/14/2003 C 7,360,207(6) 10/14/2003 06/30/2004(8) Common 867,644 $0(6) 0 I(6) See Footnote(6)
1. Name and Address of Reporting Person*
WEISEL THOMAS CAPITAL PARTNERS LLC

(Last) (First) (Middle)
One Montgomery Street, Suite 3700

(Street)
San Francisco CA 94104

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WEISEL THOMAS CAPITAL PARTNERS LP

(Last) (First) (Middle)
One Montgomery Street, Suite 3700

(Street)
San Francisco CA 94104

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
TWP CEO FOUNDERS CIRCLE AI LP

(Last) (First) (Middle)
One Montgomery Street, Suite 3700

(Street)
San Francisco CA 94104

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
TWP CEO FOUNDERS CIRCLE QP LP

(Last) (First) (Middle)
One Montgomery Street, Suite 3700

(Street)
San Francisco CA 94104

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WEISEL THOMAS CAPITAL PARTNERS DUTCH LP

(Last) (First) (Middle)
One Montgomery Street, Suite 3700

(Street)
San Francisco CA 94104

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WEISEL THOMAS CAPITAL PARTNERS DUTCH II LP

(Last) (First) (Middle)
One Montgomery Street, Suite 3700

(Street)
San Francisco CA 94104

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
WEISEL THOMAS CAPITAL PARTNERS EMPLOYEE FUND LP

(Last) (First) (Middle)
ONE MONTGOMERY STREET, SUITE 3700

(Street)
SAN FRANCISCO CA 94104

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. The amount reported in Column 4 includes 2,583,216 shares held by Thomas Weisel Capital Partners, L.P., 59,863 shares held by TWP CEO Founder's Circle (AI), L.P., 218,056 shares held by TWP CEO Founder's Circle (QP), L.P., 60,435 shares held by Thomas Weisel Capital Partners (Dutch), L.P., 60,435 shares held by Thomas Weisel Capital Partners (Dutch II), L.P., 19,074 shares held by Thomas Weisel Capital Partners Employee Fund, L.P. and 12,079 shares held by TWP 2000 Co-Investment Fund, L.P. These shares were acquired upon conversions of the securities described in footnotes 2 through 6.
2. See "Notes to Footnote 2" in Exhibit 99.2.
3. See "Notes to Footnote 3" in Exhibit 99.2.
4. See "Notes to Footnote 4" in Exhibit 99.2.
5. See "Notes to Footnote 5" in Exhibit 99.2.
6. See "Notes to Footnote 6" in Exhibit 99.2.
7. These securities are preferred stock of Acusphere and do not have an expiration date. These securities automatically converted into shares of Acusphere's Common Stock upon the consummation of Acusphere's initial public offering on October 14, 2003.
8. The 10% Secured Convertible Promissory Notes were convertible into shares of common stock anytime prior to the maturity date, June 30, 2004. These securities automatically converted into shares of Acusphere's Common Stock upon consummation of Acusphere's initial public offering on October 14, 2003.
See Signature included in Exhibit 99.1 10/14/2003
** 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).
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