-----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, V9iEgCV2+xnZXiTtz7LQz15Y9skE4aPZViE705UeZN/VO+lWAC2qN4T+rbXLPNJb adqY90+bdMDL4M0REBMBjA== 0000910680-05-000050.txt : 20050112 0000910680-05-000050.hdr.sgml : 20050112 20050112153350 ACCESSION NUMBER: 0000910680-05-000050 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20041024 FILED AS OF DATE: 20050112 DATE AS OF CHANGE: 20050112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADERETH JONATHAN CENTRAL INDEX KEY: 0001123601 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-11140 FILM NUMBER: 05525840 MAIL ADDRESS: STREET 1: C/O MEDIVISION STREET 2: PO BOX 45 INDUSTRIAL PARK CITY: YOKNEAM ISRAEL ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: OPHTHALMIC IMAGING SYSTEMS CENTRAL INDEX KEY: 0000885317 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 943035367 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 221 LATHROP WAY STREET 2: SUITE 1 CITY: SACRAMENTO STATE: CA ZIP: 95815 BUSINESS PHONE: 9166462020 MAIL ADDRESS: STREET 1: 221 LATHROP WAY STREET 2: SUITE 1 CITY: SACRAMENTO STATE: CA ZIP: 95815 FORMER COMPANY: FORMER CONFORMED NAME: OPHTHALMIC IMAGING SYSTEMS INC DATE OF NAME CHANGE: 19930328 4 1 f4-adereth102404_ex.xml X0202 4 2004-10-24 1 0000885317 OPHTHALMIC IMAGING SYSTEMS OISI 0001123601 ADERETH JONATHAN C/O OPHTHALMIC IMAGING SYSTEMS 221 LATHROP WAY, SUITE 1 SACRAMENTO CA 95815 1 0 0 0 Options to Purchase Common Stock .41 2001-09-06 4 A 0 150000 A 2011-09-05 Common Stock 150000 150000 D Options to Purchase Common Stock .41 2003-04-10 4 A 0 30000 A 2013-04-09 Common Stock 30000 180000 D Options to Purchase Common Stock 0.681 2004-10-24 4 A 0 40000 A 2014-10-23 Common Stock 40000 40000 D Exercisable immediately as to 25,000 shares and exercisable in five equal semi-annual installments as to the remaining shares, beginning September 8, 2001. Exercisable immediately as to 5,000 shares and exercisable in five equal semi-annual installments as to the remaining shares, beginning October 1, 2003. As of December 22, 2004, the Reporting Person was no longer a director of the Issuer. This Form 4 is being filed to note the Reporting Person's termination of insider reporting status and the reported holdings reflect the Reporting Person's beneficial ownership as of the date hereof. Exercisable in six equal semi-annual installments for the three years following October 24, 2004. Not applicable. /s/ Jonathan Adereth 2005-01-12 -----END PRIVACY-ENHANCED MESSAGE-----