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 |
|
1. Name and Address of Reporting Person*
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 02/03/2005 |
3. Issuer Name and Ticker or Trading Symbol
ICAGEN INC [ ICGN ] |
|||||||||||||
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
5. If Amendment, Date of Original Filed
(Month/Day/Year) |
||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
|
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 | 27,175 | I | By Medical Science Partners, L.P.(1) |
Common Stock | 19,592 | I | By Medical Science Partners II, L.P.(1) |
Common Stock | 19,233 | D |
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 | ||||
Series C Convertible Preferred Stock | (2) | (2) | Common Stock | 1,305 | (3) | D | |
Series D Convertible Preferred Stock | (2) | (2) | Common Stock | 12,365 | (3) | D | |
Series F Convertible Preferred Stock | (2) | (2) | Common Stock | 118 | (3) | D | |
Series H Convertible Preferred Stock | (2) | (2) | Common Stock | 262 | (3) | D | |
Series C Convertible Preferred Stock | (2) | (2) | Common Stock | 206,523 | (3) | I | By European Medical Ventures.(1) |
Series D Convertible Preferred Stock | (2) | (2) | Common Stock | 57,691 | (3) | I | By European Medical Ventures.(1) |
Series F Convertible Preferred Stock | (2) | (2) | Common Stock | 18,791 | (3) | I | By European Medical Ventures.(1) |
Series H Convertible Preferred Stock | (2) | (2) | Common Stock | 41,597 | (3) | I | By European Medical Ventures.(1) |
Series C Convertible Preferred Stock | (2) | (2) | Common Stock | 69,084 | (3) | I | By Medical Science II Co-Investment, L.P.(1) |
Series A Convertible Preferred Stock | (2) | (2) | Common Stock | 325,000 | (3) | I | By Medical Science Partners, L.P.(1) |
Series B Convertible Preferred Stock | (2) | (2) | Common Stock | 157,186 | (3) | I | By Medical Science Partners, L.P.(1) |
Series C Convertible Preferred Stock | (2) | (2) | Common Stock | 291,803 | (3) | I | By Medical Science Partners II, L.P(1) |
Stock Option (right to buy) | (4) | 01/01/2013 | Common Stock | 10,000 | $2.25 | D | |
Stock Option (right to buy) | (5) | 01/01/2014 | Common Stock | 25,000 | $2.25 | D |
Explanation of Responses: |
1. The reporting person is managing partner of the listed entities. The reporting person disclaims beneficial ownership of the shares except to the extent of his pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose. |
2. The Series A, Series B, Series C, Series D, Series F and Series H Convertible Preferred Stock is immediately exercisable and does not have an expiration date. Upon the closing of the Issuer's public offering, these shares will automatically convert into common stock of the Issuer. |
3. These shares are convertible on a 1-for-1 basis into common stock of the Issuer. |
4. Option fully vested one year after the date of grant (12/31/03). |
5. Option vests monthly over the three years commencing 01/01/2004. |
Remarks: |
Exhibit 24 |
Holly A. Coldiron, Attorney-in-fact | 02/02/2005 | |
** 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. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |