-----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, JG+EFHmUwvg7W9EQ3XjYzQ8CiJ4cVCa0LXwxREqxcStG5OquOfaoTes33c2iUt4Y lUZQmyw1AWtzIfbl6v4cLQ== 0001273550-04-000001.txt : 20040116 0001273550-04-000001.hdr.sgml : 20040116 20040116103047 ACCESSION NUMBER: 0001273550-04-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040113 FILED AS OF DATE: 20040116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: VAN BUSKIRK ROBERT CENTRAL INDEX KEY: 0001273550 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18170 FILM NUMBER: 04528746 BUSINESS ADDRESS: STREET 1: BIOLIFE SOLUTIONS INC STREET 2: SCIENCE 3 STE 144 SUNY PARK CITY: BINGHAMTON STATE: NY ZIP: 13902 BUSINESS PHONE: 6077772801 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BIOLIFE SOLUTIONS INC CENTRAL INDEX KEY: 0000834365 STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845] IRS NUMBER: 943076866 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: SUNY PARK SCIENCE III STREET 2: SUITE 144 CITY: BINGHAMTON STATE: NY ZIP: 13902-6000 BUSINESS PHONE: 6077772775 MAIL ADDRESS: STREET 1: SUNYPARK SCIENCE III STREET 2: STE 144 CITY: BINGHAMTON STATE: NY ZIP: 13902-6000 FORMER COMPANY: FORMER CONFORMED NAME: BIOLIFE SOLUTION INC DATE OF NAME CHANGE: 20030113 FORMER COMPANY: FORMER CONFORMED NAME: CRYOMEDICAL SCIENCES INC DATE OF NAME CHANGE: 19920703 4 1 edgar.xml PRIMARY DOCUMENT X0201 42004-01-13 0000834365 BIOLIFE SOLUTIONS INC BLFS 0001273550 VAN BUSKIRK ROBERT C/O BIOLIFE SOLUTIONS, INC. SCIENCE 3 SUITE 144 SUNY PARK BINGHAMTON NY 13902 1000Series G Convertible Preferred Stock2004-01-134P01ACommon Stock3125001DCommon Stock Warrants (right to buy).082004-01-134P01A2013-10-31Common Stock3125001DThe reported securities are included within 1 BioLife Solutions, Inc. Unit purchased by the reporting person for $25,000.00 per Unit. Each Unit consists of one share of Series G Convertible Preferred Stock convertible into 312,500 shares of common stock per share, and one warrant to purchase 312,500 shares of common stock a t a price of $0.08 per share.1 for 312,500ImmediatelySuch Preferred Stock is perpetual.Robert Van Buskirk2004-01-13 -----END PRIVACY-ENHANCED MESSAGE-----