0001209191-11-049085.txt : 20110926
0001209191-11-049085.hdr.sgml : 20110926
20110926195227
ACCESSION NUMBER: 0001209191-11-049085
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20110923
FILED AS OF DATE: 20110926
DATE AS OF CHANGE: 20110926
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: EnteroMedics Inc
CENTRAL INDEX KEY: 0001371217
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
IRS NUMBER: 000000000
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2800 Patton Rd
CITY: St Paul
STATE: MN
ZIP: 55113
MAIL ADDRESS:
STREET 1: 2800 Patton Rd
CITY: St Paul
STATE: MN
ZIP: 55113
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DOUGLAS KEVIN
CENTRAL INDEX KEY: 0001132859
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33818
FILM NUMBER: 111108174
MAIL ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 93939
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Douglas Michelle
CENTRAL INDEX KEY: 0001348445
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33818
FILM NUMBER: 111108173
MAIL ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DOUGLAS FAMILY TRUST
CENTRAL INDEX KEY: 0001268474
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33818
FILM NUMBER: 111108172
BUSINESS ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
BUSINESS PHONE: 4155262200
MAIL ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JAMES & JEAN DOUGLAS IRREVOCABLE DESCENDANTS TRUST
CENTRAL INDEX KEY: 0001268475
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33818
FILM NUMBER: 111108171
BUSINESS ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
BUSINESS PHONE: 4155262200
MAIL ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MMD 2010 Annuity Trust VI
CENTRAL INDEX KEY: 0001518639
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33818
FILM NUMBER: 111108175
BUSINESS ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
BUSINESS PHONE: 415-524-2200
MAIL ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KGD 2010 Annuity Trust VI
CENTRAL INDEX KEY: 0001518640
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-33818
FILM NUMBER: 111108170
BUSINESS ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
BUSINESS PHONE: 415-524-2200
MAIL ADDRESS:
STREET 1: 125 E. SIR FRANCIS DRAKE BLVD.
STREET 2: SUITE 400
CITY: LARKSPUR
STATE: CA
ZIP: 94939
4
1
c22781_4x0.xml
MAIN DOCUMENT DESCRIPTION
X0304
4
2011-09-23
0001371217
EnteroMedics Inc
ETRM
0001132859
DOUGLAS KEVIN
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR
CA
94939
0
0
1
1
13(d)(3) group
0001348445
Douglas Michelle
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR
CA
94939
0
0
1
1
13(d)(3) group
0001268474
DOUGLAS FAMILY TRUST
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR
CA
94939
0
0
1
1
13(d)(3) group
0001268475
JAMES & JEAN DOUGLAS IRREVOCABLE DESCENDANTS TRUST
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR
CA
94939
0
0
1
1
13(d)(3) group
0001518640
KGD 2010 Annuity Trust VI
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR
CA
94939
0
0
1
1
13(d)(3) group
0001518639
MMD 2010 Annuity Trust VI
125 E. SIR FRANCIS DRAKE BLVD., STE 400
LARKSPUR
CA
94939
0
0
1
1
13(d)(3) group
Common Stock
2011-09-23
4
P
0
435000
1.65
A
990000
D
Common Stock
2011-09-23
4
P
0
725000
1.65
A
1725000
I
By James Douglas and Jean Douglas Irrevocable Descendants' Trust
Common Stock
2011-09-23
4
P
0
290000
1.65
A
780000
I
By Douglas Family Trust
Common Stock
127500
I
By KGD 2010 Annuity Trust VI
Common Stock
127500
I
By MMD 2010 Annuity Trust VI
Warrant (right to buy)
1.90
2011-09-23
4
P
0
87000
A
2011-09-23
2016-09-23
Common Stock
87000
87000
D
Warrant (right to buy)
1.90
2011-09-23
4
P
0
145000
A
2011-09-23
2016-09-23
Common Stock
145000
145000
I
By James Douglas and Jean Douglas Irrevocable Descendants' Trust
Warrant (right to buy)
1.90
2011-09-23
4
P
0
58000
A
2011-09-23
2016-09-23
Common Stock
58000
58000
I
By Douglas Family Trust
Purchase price of $1.65 represents price for a unit consisting of 1 share of common stock and a warrant to purchase 0.2 of a share of common stock at an exercise price equal to $1.90 per share.
These shares are held directly and jointly by Kevin Douglas and Michelle Douglas.
Each of the reporting persons hereunder (individually, a "Reporting Person" and collectively the "Reporting Persons") may be deemed a member of a "group" within the meaning of Section 13(d)(3) of the Securities and Exchange Act of 1934, as amended (the "Exchange Act") or Rule 13d-5 promulgated under the Exchange Act, with one or more of the other Reporting Persons. Although the Reporting Persons are reporting such securities as if they were members of a "group", the filing of this Form 4 shall not be deemed an admission by any Reporting Person that such Reporting Person is a beneficial owner of any securities other than those directly held by such Reporting Person.
These shares are held directly by the James Douglas and Jean Douglas Irrevocable Descendants' Trust and indirectly by Kevin Douglas and Michelle Douglas. Kevin Douglas and Michelle Douglas, husband and wife, are each a co-trustee of the James Douglas and Jean Douglas Irrevocable Descendants' Trust.
These shares are held directly by the Douglas Family Trust and indirectly by Kevin Douglas. James E. Douglas, Jr. and Jean A. Douglas, husband and wife, are each a co-trustee of the Douglas Family Trust.
These shares are held directly by the KGD 2010 Annuity Trust, a grantor-retained annuity trust of which Kevin Douglas is the sole trustee, and indirectly by Kevin Douglas.
These shares are held directly by the MMD 2010 Annuity Trust, a grantor-retained annuity trust of which Michelle Douglas is the sole trustee, and indirectly by Michelle Douglas and Kevin Douglas.
/s/ Tim McGaw, attorney in fact for Kevin Douglas
2011-09-26
/s/ Tim McGaw, attorney in fact for Michelle Douglas
2011-09-26
/s/ Tim McGaw, attorney in fact for Douglas Family Trust
2011-09-26
/s/ Tim McGaw, attorney in fact for James Douglas and Jean Douglas Irrevocable Descendants? Trust
2011-09-26
/s/ Tim McGaw, attorney in fact for KGD 2010 Annuity Trust VI
2011-09-26
/s/ Tim McGaw, attorney in fact for MMD 2010 Annuity Trust VI
2011-09-26