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