SEC Form 4
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*
DELPHI VENTURES VI LP

(Last) (First) (Middle)
3000 SAND HILL ROAD
BUILDING 1, SUITE 135

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
TRANS1 INC [ TSON ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
10/22/2007
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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
Common Stock 10/22/2007 C 2,137,262 A (1) 2,137,262 D(2)
Common Stock 10/22/2007 C 21,372 A (1) 21,372 D(3)
Common Stock 10/22/2007 A 99,010(4) A $15(5) 2,236,272 D(2)
Common Stock 10/22/2007 A 990(6) A $15(5) 22,362 D(3)
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) 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
Series B Convertible Preferred Stock (7) 10/22/2007 C 1,462,195 (7) (1) Common Stock 1,462,195 (1) 0 D(2)
Series C Convertible Preferred Stock (7) 10/22/2007 C 675,067 (7) (1) Common Stock 675,067 (1) 0 D(2)
Series B Convertible Preferred Stock (7) 10/22/2007 C 14,622 (7) (1) Common Stock 14,622 (1) 0 D(3)
Series C Convertible Preferred Stock (7) 10/22/2007 C 6,750 (7) (1) Common Stock 6,750 (1) 0 D(3)
1. Name and Address of Reporting Person*
DELPHI VENTURES VI LP

(Last) (First) (Middle)
3000 SAND HILL ROAD
BUILDING 1, SUITE 135

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
DELPHI BIOINVESTMENTS VI LP

(Last) (First) (Middle)
3000 SAND HILL ROAD
BUILDING 1, SUITE 135

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
DELPHI MANAGEMENT PARTNERS VI LLC

(Last) (First) (Middle)
3000 SAND HILL ROAD
BUILDING 1, SUITE 135

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. Not applicable.
2. The reported securities are owned directly by Delphi Ventures VI, L.P. ("Delphi VI"). Delphi Management Partners VI, L.L.C. (the "General Partner"), as general partner of Delphi VI, and James J. Bochnowski, David L. Douglass, John F. Maroney, Douglas A. Roeder, and Deepika R. Pakianathan, Ph.D., the Managing Members of the General Partner, may be deemed to share voting and dispositive power over the reported shares but each disclaims beneficial ownership in the securities held by Delphi VI and Delphi BioInvestments VI, L.P. ("Delphi BioInvestments VI") except to the extent of their pecuniary interest therein.
3. The reported securities are owned directly by Delphi BioInvestments VI. The General Partner, as general partner of Delphi BioInvestments VI, and James J. Bocknowski, David L. Douglass, John F. Maroney, Douglas A. Roeder, and Deepika R. Pakianathan, Ph.D., the Managing Members of the General Partner, may be deemed to share voting and dispositive power over the reported shares but each disclaims beneficial ownership in the securities held by Delphi VI, and Delphi BioInvestments VI except to the extent of their pecuniary interest therein.
4. This amount represents the number of shares purchased by Delphi VI in the Issuer's initial public offering of Common Stock.
5. This amount reflects the purchase price of the Common Stock in the Issuer's initial public offering.
6. This amount represents the number of shares purchased by Delphi BioInvestments VI in the Issuer's initial public offering of Common Stock.
7. The reported securities automatically converted into shares of Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering on October 22, 2007.
Remarks:
The Date of Event is based upon the closing date of the Issuer's initial public offering of Common Stock. See Exhibit 99.1 - Joint Filer Information. EXHIBIT LIST: Exhibit 99.1 - Joint Filer Information
/s/ Douglas A. Roeder 10/22/2007
/s/ Douglas A. Roeder 10/22/2007
/s/ Douglas A. Roeder 10/22/2007
** 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).
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