0001209191-12-050843.txt : 20121029
0001209191-12-050843.hdr.sgml : 20121029
20121029155539
ACCESSION NUMBER: 0001209191-12-050843
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20121025
FILED AS OF DATE: 20121029
DATE AS OF CHANGE: 20121029
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: 121166957
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
X0306
4
2012-10-25
0
0000876378
SafeStitch Medical, Inc.
SFES
0001188834
HSIAO JANE PH D
4400 BISCAYNE BLVD
MIAMI
FL
33137
1
0
1
1
Chairman of the Board
Common Stock
2012-10-25
4
X
0
785383
0.25
A
785383
I
The Frost Group LLC
Common Stock
7303965
D
Common Stock
1913470
I
Hsu Gamma Investments, L.P.
Warrants
0.25
2012-10-25
4
X
0
785383
0.00
D
2007-09-04
2017-09-04
Common Stock
785383
0
I
The Frost Group, LLC
These securities are held by The Frost Group, LLC, of which the Reporting Person is a member. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of any pecuniary interest therein. Immediately following the exercise of the warrant, The Frost Group, LLC distributed these 785,383 shares of common stock to its members. In such distribution, the Reporting Person received 133,716 shares of common stock, and the other members received the balance of the shares.
Dr. Hsiao is the general partner of Hsu Gamma Investments, L.P. and disclaims benenficial ownership in the shares held by such entity except to the extent of her pecuniary interest therein.
These securities are held by The Frost Group, LLC, of which the Reporting Person is a member. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of any pecuniary interest therein.
/s/ Jane H. Hsiao
2012-10-29