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*
STERN ADAM K

(Last) (First) (Middle)
535 MADISON AVENUE 18TH FLOOR

(Street)
NEW YORK NY 10022

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/19/2007
3. Issuer Name and Ticker or Trading Symbol
Modigene Inc. [ MODG.OB ]
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, par value $0.00001 per share 1,023,871(1) I By Spencer Trask Breakthrough Partners LLC(1)
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) (2) 09/25/2016 Common Stock 85,323 $0.88 D
Stock option (right to buy) 05/09/2008 05/09/2017 Common Stock 25,000 $2 D
Warrant (right to buy) 05/09/2007 12/14/2015 Common Stock 298,403 $0.88 D
Warrant (right to buy) 05/09/2007 05/09/2012 Common Stock 143,147 $2.5 D
Explanation of Responses:
1. Held in the name of Spencer Trask Breakthrough Partners LLC ("Breakthrough"), as to which Mr. Stern shares voting and investment power. Mr. Stern disclaims beneficial ownership of the securities except to the extent of his pecuniary interest therein. Breakthrough. acquired the 1,023,871 shares of issuer common stock in exchange for 600,000 shares of common stock of Modigene Inc., a Delaware corporation ("Modigene Delaware"), pursuant to Modigene Delaware's merger with a wholly-owned subsidiary of the issuer on May 9, 2007 (the "Merger"). Of the 1,023,871 shares issued to Breakthrough in the Merger, 51,194 shares are currently being held in escrow and are subject to forfeiture during the two-year period following the Merger to satisfy claims arising as a result of Modigene Delaware's breach of its representations, warranties or covenants in the merger agreement.
2. Received in connection with the Merger in exchange for a director stock option to acquire 50,000 shares of Modigene Delaware common stock at $1.50 per share. Option was fully vested at the time of the Merger.
/s/ Adam Stern 06/19/2007
** 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 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).
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