-----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, SM0rTiCGMX4fE6LA5RN3aBhQEcfiqIEtT9vdcIUS+7PpjooXAczaAW3peF1BihOp KdyyhWYr1GmWRDf9hfdScQ== 0000897101-02-000742.txt : 20021029 0000897101-02-000742.hdr.sgml : 20021029 20021029141257 ACCESSION NUMBER: 0000897101-02-000742 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021028 FILED AS OF DATE: 20021029 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MEDAMICUS INC CENTRAL INDEX KEY: 0000833140 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 411533300 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19467 FILM NUMBER: 02801184 BUSINESS ADDRESS: STREET 1: 15301 HGHWY 55 W CITY: PLYMOUTH STATE: MN ZIP: 55447 BUSINESS PHONE: 7635592613 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: AUTH THOMAS L CENTRAL INDEX KEY: 0000938654 RELATIONSHIP: DIRECTOR STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 2266 NORTH SECOND ST CITY: NORTH ST PAUL STATE: MN ZIP: 55109 BUSINESS PHONE: 6127772690 MAIL ADDRESS: STREET 1: 2266 NORTH SECOND STREET CITY: NORTH ST PAUL STATE: MN ZIP: 55109 4 1 med-auth025150_4.htm THOMAS AUTH - FORM 4
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION

Washington, DC 20549

FORM 4

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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(h) of the Investment Company Act of 1940

o 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*

   Auth           Thomas           
2. Issuer Name and Ticker or
Trading Symbol

Medamicus, Inc. (MEDM)
3. I.R.S. Identification Number of Reporting
Person, if an entity (voluntary)

   
   
 
    (Last)       (First)       (Middle)

8 Evergreen Road
4. Statement for Month/Day/Year

10/28/2002
5. If Amendment, Date of Original (Month/Year)

   
   
 
  (Street)

North Oaks                MN              55127
6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)
7. Individual or Joint/Group Filing
(Check One)
   
(City)                (State)           (Zip)
  x  Director o  10% Owner   x Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)

 
       
     

*   If the form is filed by more than one reporting person, see instruction 4(b)(v).

 

 


Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned

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)


Code      ¦       V
4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)
                  (A)
Amount   ¦   or    ¦    Price
                  (D)
5. Amount of Securities
Beneficially Owned
Following Reported
Transactions(s)
(Instr. 3 and 4)
6. Ownership
Form:
Direct (D) or
Indirect (I)
(Instr. 4)
7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

   Common Stock            45,000     D  


Reminder:  Report on a separate line for each class of securities beneficially owned directly or indirectly.

Page 2

 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)

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)

   Code       ¦        V
5. Number of Derivative Securities
Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)

   (A)        ¦        (D)

   Option    6.95        10/28/2002        A   18,000

Page 3

 


Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)

6. Date Exercisable and
Expiration Date
(Month/Day/Year)

Date                Expiration
Exercisable   ¦   Date
7. Title and Amount
of Underlying Securities
(Instr. 3 and 4)
                  Amount or
                  Number of
Title     ¦     Shares
8. Price of Derivative
Security
(Instr. 5)
9. Number of Derivative
Securities Beneficially Owned
Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of
Derivative Securities
Beneficially Owned
at End of Month
11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)

  (1) 10/27/2010   Common Stock 18,000        18,000     D  

Explanation of Responses:
 (1) Option vests in three equal yearly installments, with the first 6,000 shares vesting on date of grant.

/s/  Thomas Auth   10/28/2002

**Signature of Reporting Person
 
Date

 Power of Attorney: April Hamlin
**   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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