-----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, LJVpMARRjzCjUrcsPR7337UkN5h1qQjcMeNhOgum4TK5l0TgZSLPYEps3ARjI99h BsFUAPqYpiOUn+j8YgA8dQ== 0001209191-10-045967.txt : 20100913 0001209191-10-045967.hdr.sgml : 20100913 20100913174430 ACCESSION NUMBER: 0001209191-10-045967 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20100910 FILED AS OF DATE: 20100913 DATE AS OF CHANGE: 20100913 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HSIAO JANE PH D CENTRAL INDEX KEY: 0001188834 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19437 FILM NUMBER: 101069904 MAIL ADDRESS: STREET 1: 4400 BISCAYNE BLVD CITY: MIAMI STATE: FL ZIP: 33137 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SafeStitch Medical, Inc. CENTRAL INDEX KEY: 0000876378 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 112962080 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4400 BISCAYNE BLVD. STREET 2: SUITE A-100 CITY: MIAMI STATE: FL ZIP: 33137 BUSINESS PHONE: 305-575-4600 MAIL ADDRESS: STREET 1: 4400 BISCAYNE BLVD. STREET 2: SUITE A-100 CITY: MIAMI STATE: FL ZIP: 33137 FORMER COMPANY: FORMER CONFORMED NAME: CELLULAR TECHNICAL SERVICES CO INC DATE OF NAME CHANGE: 19930328 4 1 doc4.xml FORM 4 SUBMISSION X0303 4 2010-09-10 0 0000876378 SafeStitch Medical, Inc. SFES.OB 0001188834 HSIAO JANE PH D 4400 BISCAYNE BLVD MIAMI FL 33137 1 0 1 1 Chairman of the Board Common Stock 2010-09-10 4 C 0 477209 1.00 A 1837209 I Hsu Gamma Investment, L.P. Common Stock 2010-09-10 4 J 0 76261 0.00 A 1913470 I Hsu Gamma Investment, L.P. Common Stock 2803965 D 10% Series A Convertible Preferred Stock 1.00 2010-09-10 4 C 0 447500 1.00 D 2010-01-12 Common Stock 477209 0 I Hsu Gamma Investment, L.P. The 10% Series A Convertible Preferred Stock was convertible into SafeStitch Medical, Inc. common stock at a price of $1.00 per share (equivalent to a conversion ratio of one share of common stock for each share of 10% Series A Convertible Preferred Stock, exclusive of accrued and unpaid dividends). The number of shares acquired includes 29,709 shares issued upon conversion of accrued and unpaid dividends. Dr. Hsiao is the general partner of Hsu Gamma Investment, L.P. and disclaims benenficial ownership in the shares held by such entity except to the extent of her pecuniary interest therein. Represents additional shares acquired by the Reporting Person pursuant to the Issuer's offer of additional shares of common stock to encourage holder-initiated conversion of 10% Series A Convertible Preferred Stock. The 10% Series A Convertible Preferred Stock has no expiration date. /s/ Jane H. Hsiao 2010-09-13 -----END PRIVACY-ENHANCED MESSAGE-----