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
MedaSorb Technologies CORP [ MSBT.OB ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 10/28/2006 | ||||||||||||||||||||||||||
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 | 10/28/2006 | G | V | 1,000,000 | D | $0 | 6,995,000 | D | ||
Common Stock | 10/28/2006 | G | V | 1,050,000 | D | $0 | 5,945,000 | D | ||
Common Stock | 10/28/2006 | G | V | 1,150,000 | D | $0 | 4,795,000 | D |
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 A Preferred Stock | $1.25 | 10/28/2006 | J(1) | 1,000,000(1) | 10/28/2006(1) | (1) | Common Stock | 800,000 | (1) | 1,000,000(1) | D | ||||
Common Stock Purchase Warrants | $2 | 10/28/2006 | J(1) | 400,000 | 10/28/2006 | 10/28/2011 | Common Stock | 400,000 | (1) | 400,000 | D | ||||
Warrants(2) | $1 | 10/28/2006 | J | 420,000 | 10/28/2006 | 10/28/2011 | Common Stock(2) | 630,000(2) | (2) | 420,000 | D |
Explanation of Responses: |
1. Shares of Series A Preferred Stock and Common Stock Purchase Warrants issued in exchange for promissory note of the Issuer in the principal amount of $1,000,000. Each share of Series A Preferred Stock, so long as it is outstanding, is convertible into 0.8 shares of Common Stock, subject to adjustment in certain cases. Each Common Stock Purchase Warrant is exercisable for one share of Common Stock at an exercise price of $2.00. Shares of Series A Preferred Stock may only be converted and Common Stock Purchase Warrants may only be exercised on 61 days' notice if such conversion or exercise would result in beneficial ownership in excess of 5% of the Common Stock of the Issuer. |
2. Each Warrant entitles the holder to acquire one share of Series A Preferred Stock and one-half Common Stock Purchase Warrant for $1.00. The Warrants were granted as a fee to Ms. Chassman for her pledge of certain securities as an inducement to certain investors to purchase shares of Series A Preferred Stock and Common Stock Purchase Warrants. Warrants may only be exercised on 61 days' notice if such exercise would result in beneficial ownership in excess of 5% of the Common Stock of the Issuer. |
MARGIE CHASSMAN | 11/17/2006 | |
** 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. |