-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, OBk5jSnIgjp9XL0utXMmg2XsreCVx/eY013r+TXQbDbNMnDepbgq6bhjElEkKapP gXSVpR4FhmyoHAcweyOPFg== 0001047469-97-003567.txt : 19971114 0001047469-97-003567.hdr.sgml : 19971114 ACCESSION NUMBER: 0001047469-97-003567 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 19971110 FILED AS OF DATE: 19971112 SROS: NASD SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CHOICETEL COMMUNICATIONS INC /MN/ CENTRAL INDEX KEY: 0001031927 STANDARD INDUSTRIAL CLASSIFICATION: TELEPHONE COMMUNICATIONS (NO RADIO TELEPHONE) [4813] IRS NUMBER: 411649949 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: SEC FILE NUMBER: 000-23017 FILM NUMBER: 97712428 BUSINESS ADDRESS: STREET 1: 9724 10TH AVE NORTH STREET 2: 612-544-1260 CITY: PLYMOUTH STATE: MN ZIP: 55441 MAIL ADDRESS: STREET 1: 9724 10TH AVE NORTH CITY: PLYMOUTH STATE: MN ZIP: 55441 FORMER COMPANY: FORMER CONFORMED NAME: INTELLIPHONE INC DATE OF NAME CHANGE: 19970625 COMPANY DATA: COMPANY CONFORMED NAME: HEGSTROM ROBERT A CENTRAL INDEX KEY: 0001045718 STANDARD INDUSTRIAL CLASSIFICATION: [] DIRECTOR FILING VALUES: FORM TYPE: 3 BUSINESS ADDRESS: STREET 1: C/O CHOICETEL COMMUNICATIONS INC STREET 2: 9724 10TH AVENUE NORTH CITY: PLYMOUTH STATE: MN ZIP: 55441 BUSINESS PHONE: 6125441260 MAIL ADDRESS: STREET 1: C/O CHOICETEL COMMUNICATIONS INC STREET 2: 9724 10TH AVENUE NORTH CITY: PLYMOUTH STATE: MN ZIP: 55441 3 1 FORM 3 - ------- ------------------------------- FORM 3 OMB APPROVAL - ------- OMB NUMBER 3235-0104 EXPIRES: FEBRUARY 1, 1994 ESTIMATED AVERAGE BURDEN HOURS PER RESPONSE.........0.5 ------------------------------ U.S. SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP AND SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 --------------------------------------------------------------------------------------------------------------------------------- |1. Name and Address of Reporting |2. Date of Event |4. Issuer Name and Ticket or Trading Symbol | | Person | Requiring | | | | Statement | CHOICETEL COMMUNICATIONS, INC. (PHON) | | | (Month/Day/ | | | HEGSTROM ROBERT A. | Year) | | | |November 10, 1997| | |---------------------------------------------------------------------------------------------------------------------------------| | (Last) (First) (Middle) |3. IRS or Social |5. Relationship of Reporting |6. If Amendment, Date | | | Security | Person to Issuer | of Original | |c/o CHOICETEL COMMUNICATIONS, INC.| Number of | (Check all applicable) | (Month/Day/Year) | | 9724 10th AVENUE NORTH | Reporting | X Director ___10% Owner | | |----------------------------------| Person | ___Officer ___ Other | | | (Street) | (Voluntary) | (give title below)(specify below)|-----------------------------------------| | | | |7. Individual or Joint/Group Filing | | | | | (Check Applicable Line) | | | | | | |PLYMOUTH MINNESOTA 55441| | | X Form filed by One Reporting Person | |----------------------------------| | |__ Form filed by More than One Reporting | | (City) (State) (Zip) | | | Person | | |----------------------------------------------------------------------------------------------| | | TABLE 1 -- NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED | |---------------------------------------------------------------------------------------------------------------------------------| |1. Title of Security | 2. Amount of Securities | 3. Ownership Form: | 4. Nature of Indirect Beneficial | | (Instr. 4) | Beneficially Owned | Direct (D) or | Ownership (Instr. 5) | | | (Instr. 4) | Indirect (I) | | | | | (Instr. 5) | | |---------------------------------------------------------------------------------------------------------------------------------| | | | | | |----------------------------------|----------------------------------------------------------------------------------------------| | | | | | |----------------------------------|----------------------------------------------------------------------------------------------| | | | | | |----------------------------------|----------------------------------------------------------------------------------------------| | | | | | |----------------------------------|----------------------------------------------------------------------------------------------| | | | | | |----------------------------------|----------------------------------------------------------------------------------------------| | | | | | |----------------------------------|----------------------------------------------------------------------------------------------| | | | | | |----------------------------------|----------------------------------------------------------------------------------------------| | | | | | ----------------------------------|---------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) (Print or Type Responses) SEC 1473 (3/91)
FORM 3 (continued) TABLE II -- DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, CONVERTIBLE SECURITIES) ---------------------------------------------------------------------------------------------------------------------------------- | 1. Title of Derivative | 2. Date Exercisable | 3. Title and Amount of | 4. Conver- | 5. Owner- | 6. Nature of | | Security (Instr. 4) | and Expiration | Securities | sion or | ship | Indirect | | | Date (Month/Day/ | Underlying | Exercise | Form of | Beneficial| | | Year) | Derivative Security | Price of | Deriv- | Ownership | | | | (Instr. 4) | Deriv- | ative | (Instr. 5)| | | | | ative | Security | | | | | | Security | Direct (D) | | | | | | | or Indirect | | | | | | | (I) | | | | | | | (Instr. 5) | | | -----------------------------------------------------------------------------------------------------| | | Date |Expiration | | Amount or| | | | | | Exercisable | Date | Title | Number of| | | | | | | | | Shares | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | ---------------------------------------------------------------------------------------------------------------------------------- Explanation of Responses: ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. /s/ Robert A. Hegstrom November 10, 1997 ---------------------- ----------------- SEE 18 U.S.C. (1001 and 15 U.S.C. 78ff(a). **Signature of Date Reporting Person Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, Page 2 SEE Instruction 6 for procedure. SEC 1473 (3/91)
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