SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
HENSON MICHAEL R

(Last) (First) (Middle)
610 PALOMAR AVENUE

(Street)
SUNNYVALE CA 94085

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/15/2005
3. Issuer Name and Ticker or Trading Symbol
MICRUS ENDOVASCULAR CORP [ MEND ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 74,177 D
Common Stock 25,388 I Michael Henson Annuity Trust No. 1
Common Stock 25,388 I Linda Henson Annuity Trust No. 1
Common Stock 2,577 I Michael R. Henson IRA Rollover
Common Stock 2,577 I Linda A. Henson IRA Rollover
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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: 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
Stock Option (right to buy) (1) 01/20/2010 Common Stock 8,888 $0.68 D
Stock Option (right to buy) (2) 11/29/2010 Common Stock 13,333 $0.68 D
Stock Option (right to buy) (2) 10/24/2011 Common Stock 13,333 $0.77 D
Stock Option (right to buy) (2) 11/25/2002 Common Stock 13,333 $1.01 D
Stock Option (right to buy) (2) 06/24/2013 Common Stock 29,787 $0.77 D
Stock Option (right to buy) (2) 10/29/2013 Common Stock 13,333 $1.15 D
Stock Option (right to buy) (3) 06/24/2014 Common Stock 17,777 $13.05 D
Stock Option (right to buy) (3) 11/15/2014 Common Stock 8,888 $5.63 D
Stock Option (right to buy) (3) 11/15/2014 Common Stock 22,222 $5.63 D
Convertible Warrant(4) (5) (6) Common Stock 3,333 $7.52 D
Convertible Warrant(4) (5) (6) Common Stock 19,572 $7.52 I JAIC-Henson MedFocus Fund, LLC
Convertible Warrant(7) (5) (6) Common Stock 958 $7.52 D
Convertible Warrant(7) (5) (6) Common Stock 857 $7.52 I Henson Family Trust, Michael Henson, Trustee
Convertible Warrant(7) (5) (6) Common Stock 3,901 $7.52 I JAIC-Henson MedFocus Fund, LLC
Convertible Warrant(4) (5) 01/01/2011 Common Stock 13,888 (8) I JAIC-Henson MedFocus Fund, LLC
Convertible Warrant(4) (5) 01/01/2011 Common Stock 1,388 (8) I JAIC-Henson MedFocus Fund II, LLC
Series A Preferred Stock (5) (9) Common Stock 19,777 (10) I Michael Henson Annuity Trust No. 1
Series A Preferred Stock (5) (9) Common Stock 19,777 (10) I Linda Henson Annuity Trust No. 1
Series B Preferred Stock (5) (9) Common Stock 8,888 (11) I Michael R. Henson, TTEE Henson Family Trust, 1/8/97
Series D Preferred Stock (5) (9) Common Stock 6,387 (10) I Henson Family Trust, Michael Henson, Trustee
Series D Preferred Stock (5) (9) Common Stock 29,057 (10) I JAIC-Henson MedFocus Fund, LLC
Series D-3 Preferred Stock (5) (9) Common Stock 6,666 (10) I Michael R. Henson, TTEE Henson Family Trust, 1/8/87
Series D-3 Preferred Stock (5) (9) Common Stock 39,144 (10) I JAIC-Henson MedFocus Fund, LLC
Series E Preferred Stock (5) (9) Common Stock 55,555 (10) I JAIC-Henson MedFocus Fund, LLC
Explanation of Responses:
1. 1/4 vests at one year anniversary, 1/48th of entire amount each month thereafter.
2. 100% vested at 1 year anniversary.
3. Grant vests monthly over 1 year duration.
4. Common Stock Warrant
5. Immediately Exerciseable
6. Five years from the date of issuance or before the initial public offering.
7. Series D Preferred Warrant
8. 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.
9. N/A
10. Converts on a 1 to 1 basis.
11. Each share of Series B Preferred stock converts into 1.32 shares.
Remarks:
Michael R. Henson by Robert A. Stern, Attorney-in-Fact. 06/15/2005
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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