-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, NG9GBOGl66ka1er8PMjqpsSDS+YxYckaZHtzCgZRC1xrvC3K9U80XNdNhL4Ny+io tclDFyBEpkuKbuiufQuU1g== 0001209191-05-033313.txt : 20050623 0001209191-05-033313.hdr.sgml : 20050623 20050623190710 ACCESSION NUMBER: 0001209191-05-033313 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050621 FILED AS OF DATE: 20050623 DATE AS OF CHANGE: 20050623 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HOLUBOW FRED CENTRAL INDEX KEY: 0000905478 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51323 FILM NUMBER: 05913498 BUSINESS ADDRESS: STREET 1: 1844 HUDSON CITY: CHICAGO STATE: IL ZIP: 60614 BUSINESS PHONE: 3129437077 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MICRUS ENDOVASCULAR CORP CENTRAL INDEX KEY: 0001028318 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 BUSINESS ADDRESS: STREET 1: 610 PALOMAR AVENUE CITY: SUNNYVALE STATE: CA ZIP: 94085 BUSINESS PHONE: 4088305900 MAIL ADDRESS: STREET 1: 610 PALOMAR AVENUE CITY: SUNNYVALE STATE: CA ZIP: 94085 FORMER COMPANY: FORMER CONFORMED NAME: MICRUS CORP DATE OF NAME CHANGE: 19961205 4 1 doc4.xml FORM 4 SUBMISSION X0202 4 2005-06-21 0 0001028318 MICRUS ENDOVASCULAR CORP MEND 0000905478 HOLUBOW FRED 610 PALOMAR AVENUE SUNNYVALE CA 94085 1 0 0 0 Common Stock 11111 D Common Stock 2005-06-21 4 C 0 11111 A 22222 D Common Stock 2005-06-21 4 C 0 6666 A 28888 D Common Stock 2005-06-21 4 X 0 1056 A 29944 D Series C Preferred Stock 2005-06-21 4 C 0 11111 0.00 D Common Stock 11111 0 D Series D-3 Preferrred Stock 2005-06-21 4 C 0 6666 0.00 D Common Stock 6666 0 D Common Stock Warrant 7.52 2005-06-21 4 X 0 3333 0.00 D Common Stock 3333 0 D Converts on a 1 to 1 basis. The shares were acquired by the net exercise of warrants. N/A The Common Warrants were converted and exercised for Common Stock at the closing of the initial public offering. The warrants were net exercised. Immediately Exerciseable Five years from the date of issuance or at the close of initial public offering. /s/ Fred Holubow by Robert A. Stern, Attorney-in-Fact. 2005-06-23 -----END PRIVACY-ENHANCED MESSAGE-----