FORM 4 o Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). (Print or Type Responses) |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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1. | Name and Address of Reporting Person* | 2. | Issuer Name and Ticker or Trading Symbol | 6. | Relationship of Reporting Person(s) to Issuer (Check all applicable) | |||||||||||||||
Bisimis | Ari | MacroPore Biosurgery, Inc. | X Director | 10% Owner | ||||||||||||||||
(Last) | (First) | (Middle) | 3. | I.R.S. Identification Number of Reporting Person (voluntary) | 4. | Statement for Month/Day/Year | X Officer (give title below) |
Other (specify below) |
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6740 Top Gun Street | November 13, 2002 | Chief Financial Officer | ||||||||||||||||||
(Street) | 5. | If Amendment, Date of Original (Month/Day/Year) | 7. | Individual or Joint/Group Filing (Check Applicable Line) X Form filed by One Reporting Person Form filed by More than One |
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San Diego | CA | 92121 | Reporting Person | |||||||||||||||||
(City) | (State) | (Zip) | ||||||||||||||||||
Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||||||||||||
1. | Title of Security (Instr. 3) |
2. | Transaction Date | 2A. | Deemed Execution Date, if any | 3. | Transaction Code (Instr. 8) |
4. | Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. | Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) |
6. | Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. | Nature of Indirect Beneficial Ownership (Instr. 4) |
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(Month/Day/Year) | (Month/Day/Year) | |||||||||||||||||||||||||||||||||||
Code | V | Amount | (A) or (D) | Price | ||||||||||||||||||||||||||||||||
Common Stock | 11/13/02(1) | A(2) | 10,684 | A | (2) | 130,302(3) | D | |||||||||||||||||||||||||||||
Table II Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. | Title of Derivative Security (Instr. 3) |
2. | Conversion or Exercise Price of Derivative Security | 3. | Transaction Date (Month/Day/Year) |
3A. | Deemed Execution Date, if any (Month/Day/Year) |
4. | Transaction Code (Instr. 8) |
5. | Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
6. | Date Exercisable and Expiration Date (Month/Day/Year) | |||||||||||||||||||
Code | V | (A) | (D) | Date Exercisable |
Expiration Date | |||||||||||||||||||||||||||
7. | Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. | Price of Derivative Security (Instr. 5) |
9. | Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. | Ownership Form of Derivative Securities: Direct (D) or Indirect (I) (Instr. 4) | 11. | Nature of Indirect Beneficial Ownership (Instr. 4) |
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Title | Amount or Number of Shares | |||||||||||||||||||
Explanation of Responses:
(1) The transaction date was fixed at the effective closing of the Merger between StemSource Inc. and MacroPore Biosurgery, Inc.
(2) Mr. Bisimis acquired the shares by virtue of the merger exchange of 19,987 preferred shares of StemSource Inc. in return for 10,684 shares of MacroPore Biosurgery, Inc. The MacroPore shares were
valued at $4.15 each on the date of closing.
(3) The number of securities beneficially owned at the date for which this statement was prepared does not include any adjustment for transactions which occurred subsequently but were reported prior
to this filing. Taking into account this subsequent filing the total number of shares beneficially owned as of the report on December 3, 2002 is 80,302.
/s/ Ari Bisimis | 01/30/03 | |
**Signature of Reporting Person |
Date |
Reminder: |
Report on a separate line for each class of securities beneficially owned directly or indirectly. |
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* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v) |
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** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
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Note: |
File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
http://www.sec.gov/divisions/corpfin/forms/form4.htm
Last update: 09/05/2002