FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
NUVASIVE INC [ NUVA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 05/18/2004 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 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) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Series D Preferred Stock | 05/18/2004 | C | 3,952,570(2) | D | (1) | 0 | I | See footnotes(3)(4) | ||
Common Stock | 05/18/2004 | C | 1,581,028(2) | A | (1) | 0 | I | See footnotes(4)(6) | ||
Series D-1 Preferred Stock | 05/18/2004 | C | 2,173,914(5) | D | (1) | 0 | I | See footnotes(4)(7) | ||
Common Stock | 05/18/2004 | C | 869,566(5) | A | (1) | 0 | I | See footnotes(4)(8) | ||
Common Stock | 05/18/2004 | C | 201,021(11) | A | (1) | 0 | I | See footnotes(4)(9) | ||
Common Stock | 05/18/2004 | C | 16,583(12) | A | (1) | 0 | I | See footnotes(4)(9) | ||
Common Stock | 05/18/2004 | C | 114,869(13) | A | (1) | 0 | I | See footnotes(4)(9) | ||
Common Stock | 05/18/2004 | C | 7,747(14) | A | (1) | 0 | I | See footnotes(4)(10) | ||
Common Stock | 05/18/2004 | C | 639(15) | A | (1) | 0 | I | See footnotes(4)(10) | ||
Common Stock | 05/18/2004 | C | 4,427(16) | A | (1) | 2,795,880 | I | See footnotes(4)(10) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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) | 7. Title and Amount of Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Warrant (Right to Purchase Common Stock) | $0.63 | 05/18/2004 | X | 213,130(11) | 07/11/2002 | 07/11/2009 | Common Stock | 213,130(11) | $0.63 | 0 | I | See footnotes(4)(17) | |||
Warrant (Right to Purchaes Common Stock) | $0.63 | 05/18/2004 | X | 17,582(12) | 07/29/2002 | 07/11/2009 | Common Stock | 17,582(12) | $0.63 | 0 | I | See footnotes(4)(17) | |||
Warrant (Right to Purchase Common Stock) | $0.63 | 05/18/2004 | X | 121,788(13) | 06/19/2003 | 06/19/2010 | Common Stock | 121,788(13) | $0.63 | 0 | I | See footnotes(4)(17) | |||
Warrant (Right to Purchase Common Stock) | $0.63 | 05/18/2004 | X | 8,214(14) | 07/11/2002 | 07/11/2009 | Common Stock | 8,214(14) | $0.63 | 0 | I | See footnotes(4)(18) | |||
Warrant (Right to Purchase Common Stock) | $0.63 | 05/18/2004 | X | 678(15) | 07/29/2002 | 07/11/2009 | Common Stock | 678(15) | $0.63 | 0 | I | See footnotes(4)(18) | |||
Warrant (Right to Purchase Common Stock) | $0.63 | 05/18/2004 | X | 4,694(16) | 06/19/2003 | 06/19/2010 | Common Stock | 4,694(16) | $0.63 | 0 | I | See footnotes(4)(18) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Per SEC Instruction, column left blank. |
2. The reported shares of Series D Preferred Stock were converted to Common Stock based on a conversion ratio of 0.4 shares of Common Stock per share of Series D Preferred Stock. |
3. Represents 3,805,891 shares beneficially owned by William Blair Capital Partners VII QP, L.P. and 146,679 shares beneficially owned by William Blair Capital Partners VII, L.P. |
4. The amounts shown in Table I and Table II represent the beneficial ownership of the Issuer's equity securities by William Blair Capital Partners VII QP, L.P. and William Blair Capital Partners VII, L.P., a portion of which may be deemed attributable to William Blair Capital Management VII, L.L.C. and William Blair Capital Management VII, L.P., because William Blair Capital Management VII, L.P. is the general partner of William Blair Capital Partners VII QP, L.P. and William Blair Capital Partners VII, L.P and William Blair Capital Management VII, L.L.C. is the general partner of William Blair Capital Management VII, L.P The actual pro rata portion of such beneficial ownership that may be deemed to be attributable to such Reporting Person is not readily determinable because it is subject to several variables. |
5. The reported shares of Series D-1 Preferred Stock were converted to Common Stock based on a conversion ratio of 0.4 shares of Common Stock per share of Series D-1 Preferred Stock. |
6. Represents 1,522,356 shares beneficially owned by William Blair Capital Partners VII QP, L.P. and 58,672 shares beneficially owned by William Blair Capital Partners VII, L.P. |
7. Represents 2,093,240 shares beneficially owned by William Blair Capital Partners VII QP, L.P. and 80,674 shares beneficially owned by William Blair Capital Partners VII, L.P. |
8. Represents 837,296 shares beneficially owned by William Blair Capital Partners VII QP, L.P. and 32,270 shares beneficially owned by William Blair Capital Partners VII, L.P. |
9. Represents shares beneficially owned by William Blair Capital Partners VII QP. LP. |
10. Represents shares beneficially owned by William Blair Capital Partners VII, L.P. |
11. The warrant was exercised upon the closing of the initial public offering of Common Stock of the Issuer through a net exercise feature at the initial public offering price of $11.00 into 201,021 shares of Common Stock. |
12. The warrant was exercised upon the closing of the initial public offering of Common Stock of the Issuer through a net exercise feature at the initial public offering price of $11.00 into 16,583 shares of Common Stock. |
13. The warrant was exercised upon the closing of the initial public offering of Common Stock of the Issuer through a net exercise feature at the initial public offering price of $11.00 into 114,869 shares of Common Stock. |
14. The warrant was exercised upon the closing of the initial public offering of Common Stock of the Issuer through a net exercise feature at the initial public offering price of $11.00 into 7,747 shares of Common Stock. |
15. The warrant was exercised upon the closing of the initial public offering of Common Stock of the Issuer through a net exercise feature at the initial public offering price of $11.00 into 639 shares of Common Stock. |
16. The warrant was exercised upon the closing of the initial public offering of Common Stock of the Issuer through a net exercise feature at the initial public offering price of $11.00 into 4,427 shares of Common Stock. |
17. Represents warrants beneficially owned by William Blair Capital Partners VII QP. L.P. |
18. Represents warrants beneficially owned by William Blair Capital Partners VII, L.P. |
/s/ Kevin O'Boyle, Attorney-in-fact for William Blair Capital Mangement VII, L.L.C. | 05/19/2004 | |
/s/ Kevin O'Boyle, Attorney-in-fact for William Blair Capital Mangement VII, L.P. | 05/19/2004 | |
/s/ Kevin O'Boyle, Attorney-in-fact for William Blair Capital Partners VII QP, L.P. | 05/19/2004 | |
/s/ Kevin O'Boyle, Attorney-in-fact for William Blair Capital Partners VII, L.P. | 05/19/2004 | |
** 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 4 (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. |