-----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, JyGcAhulbU268cc4u2DYFUKP/J+w7+L9ZqTjkChjiHt2nuYfrKjAacmvRyRkmEfv WWxMoT+fB70vE/X0PRHjvw== 0001179110-04-016159.txt : 20040810 0001179110-04-016159.hdr.sgml : 20040810 20040810163929 ACCESSION NUMBER: 0001179110-04-016159 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040806 FILED AS OF DATE: 20040810 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COHN JAY N MD CENTRAL INDEX KEY: 0001096058 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-24635 FILM NUMBER: 04964859 BUSINESS ADDRESS: STREET 1: 4848 RUSSELL AVENUE SOUTH CITY: MINNEAPOLIS STATE: MN ZIP: 55410 MAIL ADDRESS: STREET 1: 4848 RUSSELL AVENUE SOUTH CITY: MINNEAPOLIS STATE: MN ZIP: 55410 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HYPERTENSION DIAGNOSTICS INC /MN CENTRAL INDEX KEY: 0001058828 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 411618036 STATE OF INCORPORATION: MN FISCAL YEAR END: 0630 BUSINESS ADDRESS: STREET 1: 2915 WATERS ROAD SUITE 108 CITY: EAGAN STATE: MN ZIP: 55121-1562 BUSINESS PHONE: 6126879999 4 1 edgar.xml FORM 4 - X0202 4 2004-08-06 0 0001058828 HYPERTENSION DIAGNOSTICS INC /MN HDII 0001096058 COHN JAY N MD 2915 WATERS ROAD, SUITE 108 EAGAN MN 55121 1 0 0 0 Common Stock 702350 D Common Stock 12500 I By wife Common Stock 2004-08-06 4 C 0 305338 0.17 A 305338 D Series A Preferred Stock Common Stock 38400 460800 D Common Stock Warrant (right to buy) Common Stock 488542 488542 D Common Stock Warrant (right to buy) Common Stock 427474 427474 D Series A Preferred Stock Warrant (right to buy) Series A Preferred Stock 30720 30720 D Series A Preferred Stock Warrant (right to buy) Series A Preferred Stock 26880 26880 D Options (right to buy) Common Stock 352211 352211 D Options (right to buy) Common Stock 100000 100000 D Options (right to buy) Common Stock 5000 5000 D Options (right to buy) Common Stock 3000 3000 D Options (right to buy) Common Stock 3000 3000 D Options (right to buy) Common Stock 3000 3000 D Options (right to buy) Common Stock 3000 3000 D Options (right to buy) Common Stock 300000 300000 D Common Stock Warrant (right to buy) 0.17 2004-08-06 4 C 0 305338 0.17 D 2004-11-09 Common Stock 610676 305338 D Series A Preferred Stock Warrant (right to buy) 2.04 2004-08-06 4 C 0 19200 2.04 D 2004-11-09 Series A Preferred Stock 38400 19200 D Series A Preferred Stock 2.04 2004-08-06 4 C 0 19200 2.04 A Series A Preferred Stock 19200 19200 D Previously reported. See Table I. The purchase represents reporting person's exercise of the issuer's A-1 Preferred Stock Warrant and A-2 Common Stock Warrant. Expiration date extended to November 9, 2004; shares issued on August 6, 2004. Not applicable. /s/ Julie Stewart, by power of attorney 2004-08-09 -----END PRIVACY-ENHANCED MESSAGE-----