SEC Form 3
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*
Hinohara Tomoaki

(Last) (First) (Middle)
C/O FOXHOLLOW TECHNOLOGIES, INC.
740 BAY ROAD

(Street)
REDWOOD CITY CA 94063

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/27/2004
3. Issuer Name and Ticker or Trading Symbol
FOXHOLLOW TECHNOLOGIES, INC. [ FOXH ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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 35,000 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Series A Convertible Preferred Stock (3) (4) Common Stock 27,421 (5) I(1) By Hinohara Trust
Series A Convertible Preferred Stock (3) (4) Common Stock 13,710 (5) I(2) By Hinohara Associates, L.P.
Series B Convertible Preferred Stock (3) (4) Common Stock 2,315 (6) D
Series E Convertible Preferred Stock (3) (4) Common Stock 16,666 (5) I(1) By Hinohara Trust
Stock Option (Right to Buy) (3) 06/28/2011 Common Stock 3,750 $0.84 D
Stock Option (Right to Buy) (3) 03/10/2013 Common Stock 12,500 $0.32 D
Stock Option (Right to Buy) (3) 07/26/2014 Common Stock 15,000 $4 D
Explanation of Responses:
1. Dr. Hinohara is a trustee of the Hinohara Trust and disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
2. Dr. Hinohara is a general partner of Hinohara Associates, L.P. and disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein.
3. Immed.
4. N/A
5. 1-for-1
6. 1-for-1.367
Remarks:
The Date of Event is based upon the date of effectiveness of the Issuer's Registration Statement on Form S-1 filed in connection with the Issuer's initial public offering, estimated to be on or about October 27, 2004.
/s/ Tomoaki Hinohara 10/25/2004
** 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.
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