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) 01/25/2005 |
3. Issuer Name and Ticker or Trading Symbol
INNOVATIVE MICRO TECHNOLOGY INC [ OTC ] |
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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) |
Series A Redeemable Preferred Stock | 352,941 | D |
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 | ||||
Series A-1 Convertible Preferred Stock | (1) | (1) | Common Stock | 2,000,010 | (2) | D | |
Warrants to Purchase Common Stock | 03/15/2006 | 01/23/2008 | Common Stock | 176,471(3) | $0.3 | D |
Explanation of Responses: |
1. The shares of Seris A-1 Convertible Preferred Stock are immediately convertible into shares of Common Stock and do not have an expiration date. |
2. Shares of Series A-1 Convertible Preferred Stock convert at a rate of 5.6667 shares of Common Stock for each shares of Series A-1 Convertible Preferred Stock. |
3. The number of shares of Common Stock into which the Warrant is exercisable may be adjusted downward (potentially cancelling the Warrant if the number of shares reaches zero) according to a formula based upon the Issuer's economic performance during the 2005 calendar year. |
BAVP VII, L.P., By BA Venture Partners VII, LLC, By /s/ Kate Mitchell, Managing Member | 02/04/2005 | |
** 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. |