1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Convertible Warrant
(1)
|
Â
(2)
|
01/01/2011 |
Common Stock
|
13,888
(3)
|
$
(4)
|
I
|
JAIC-Henson MedFocus Fund II, LLC
|
Series B Preferred Stock
|
Â
(2)
|
Â
(5)
|
Common Stock
|
8,888
|
$
(6)
|
I
|
Michael R. Henson, TTEE Henson Family Trust 1/8/87
|
Series D Preferred Stock
|
Â
(2)
|
Â
(5)
|
Common Stock
|
7,342
(7)
|
$
(8)
|
D
(7)
|
Â
|
Series E Preferred Stock
|
Â
(2)
|
Â
(5)
|
Common Stock
|
27,777
(9)
|
$
(8)
|
I
|
JAIC-Henson MedFocus Fund, LLC
|
Series E Preferred Stock
|
Â
(2)
|
Â
(5)
|
Common Stock
|
27,777
|
$
(8)
|
I
|
JAIC-Henson MedFocus Fund II, LLC
|
* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
Common Stock Warrant |
(2) |
Immediately Exerciseable |
(3) |
This amount was erroneously reflected as 1,388 on the original Form 3. |
(4) |
If the initial price to the public of the common stock sold is less than $13.50 per share, these warrants become exercisable at $0.000225 per share into an additional number of shares of common stock equal to 1,343,260 multiplied by the quotient of (i) $13.50 less such initial price to the public, divided by (ii) such initial price to the public. If the initial price to the public of the common stock sold is greater than or equal to $13.50 per share, the warrants are not exercisable into shares of common stock. |
(5) |
Not Applicable. |
(6) |
Each share of Series B Preferred stock converts into 1.3157894 shares. The original Form 3 reflected a 1.32 conversion rate. |
(7) |
On the original Form 3, the ownership of 6,387 of these shares of Series D Preferred Stock was reflected as indirectly held by the Henson Family Trust, Michael Henson, Trustee but is held directly by Michael Henson. The remaining 958 shares were originally reflected as a Convertible Series D Preferred Warrant, but that warrant was exercised in April 2005 and should have been listed as Series D Preferred Stock. |
(8) |
Converts on a 1 to 1 basis. |
(9) |
On the original Form 3, Column 3 reflected 55,555 shares of Series E Preferred Stock as indirectly held by the JAIC-Henson MedFocus Fund, LLC. This number was incorrect as 27,777 of these shares were indirectly held by the JAIC-Henson MedFocus Fund II, LLC. |