FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 03/31/2005 |
3. Issuer Name and Ticker or Trading Symbol
ARBIOS SYSTEMS INC [ ABOS ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 100,000 | I | See Note(1) |
Common Stock | 5,000 | I | See Note(2) |
Common Stock | 5,000 | I | See Note(3) |
Common Stock | 5,000 | I | See Note(4) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Warrants to buy Common Stock | 10/20/2003 | 10/20/2006 | Common Stock | 100,000 | $2.5 | I | See Note(1) |
Stock Option (right to buy) | 12/09/2003 | 12/09/2008 | Common Stock | 75,000 | $1 | D | |
Stock Option (right to buy) | 01/15/2004(5) | 01/13/2009 | Common Stock | 100,000 | $1 | D | |
Warrant to buy Common Stock | 02/01/2005 | 02/01/2010 | Common Stock | 200,000 | $2.9 | I | See Note(1) |
Stock Option (right to buy) | 02/01/2005 | 02/01/2010 | Common Stock | 75,000 | $2.9 | D | |
Stock Option (right to buy) | 03/31/2005(6) | 03/30/2010 | Common Stock | 200,000 | $1.65 | D |
Explanation of Responses: |
1. Shares and warrants are held by AFO Capital Advisors LLC of which Reporting Person is owner and manager. Reporting Person has voting and investment control of these securities. |
2. Shares are held by The Jay H. Oyer and Amy Factor Family Foundation of which Reporting Person is Trustee. Reporting Person has voting and investment control of these shares. |
3. Shares are held by The Melissa H. Oyer Trust of which Reporting Person is Trustee. Reporting Person has voting and investment control of these shares. |
4. Shares are held by The Zachary D. Oyer Trust of which Reporting Person is Trustee. Reporting Person has voting and investment control of these shares. |
5. Stock Option vests at the rate of 1/16th per month starting Januray 15, 2004. |
6. Stock Option vests as to 80,000 on March 31, 2005 with the remaining shares vesting in monthly installments of 6,000 shares commencing April 1, 2005. |
/s/ Amy Factor | 04/11/2005 | |
** 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 5 (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. |