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
THERMAGE INC [ THRM ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 11/10/2006 | ||||||||||||||||||||||||||
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 | ||||||
Common Stock | 11/10/2006 | P | V | 92,196(6) | A | $7 | 92,196(7) | I(2) | By Morgenthaler Venture Partners V, L.P. | |
Common Stock | 11/10/2006 | P | V | 48,253(6) | A | $7 | 48,253(8) | I(3) | By Morgenthaler Partners VII, L.P. | |
Common Stock | 11/15/2006 | C | V | 1,798,741 | A | (1) | 1,890,937(7) | I(2) | By Morgenthaler Venture Partners V, L.P. | |
Common Stock | 11/15/2006 | C | V | 941,413 | A | (1) | 989,666(8) | I(3) | By Morgenthaler Partners VII, L.P. |
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 | ||||||||
Series B Convertible Preferred Stock | (4) | 11/15/2006 | C | V | 1,132,075 | (5) | (1) | Common Stock | 1,132,075 | (1) | 0 | I(2) | By Morgenthaler Venture Partners V, L.P. | ||
Series C Convertible Preferred Stock | (4) | 11/15/2006 | C | V | 666,666 | (5) | (1) | Common Stock | 666,666 | (1) | 0 | I(2) | By Morgenthaler Venture Partners V, L.P. | ||
Series C Convertible Preferred Stock | (4) | 11/15/2006 | C | V | 941,413 | (5) | (1) | Common Stock | 941,413 | (1) | 0 | I(3) | By Morgenthaler Partners VII, L.P. | ||
Director Stock Options (right to buy) | (9) | (9) | (9) | Common Stock | 40,000(9) | 40,000 | D |
Explanation of Responses: |
1. Not applicable. |
2. The reported securities are owned directly by Morgenthaler Venture Partners V, L.P. and indirectly by Morgenthaler Management Partners V, LLC as general partner of Morgenthaler Venture Partners V, L.P. Mr. Shaffer shares voting and investment control over all securities held by Morgenthaler Venture Partners V, L.P. and Morgenthaler Management Partners V, LLC. Mr. Shaffer disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. |
3. The reported securities are owned directly by Morgenthaler Partners VII, L.P. and indirectly by Morgenthaler Management Partners VII, LLC as general partner of Morgenthaler Partners VII, L.P. Mr. Shaffer shares voting and investment control over all securities held by Morgenthaler Partners VII, L.P. and Morgenthaler Management Partners VII, LLC. Mr. Shaffer disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. |
4. 1-for-1. |
5. Immediately. |
6. These shares were purchased from the underwriters as provided for in the Issuer's prospectus dated November 9, 2006. |
7. Following all transactions reported hereunder, Mr. Shaffer indirectly holds an aggregate of 1,890,937 shares of common stock by Morgenthaler Venture Partners V, L.P. |
8. Following all transactions reported hereunder, Mr. Shaffer indirectly holds an aggregate of 989,666 shares of common stock by Morgenthaler Partners VII, L.P. |
9. Immediately prior to Mr. Shaffer's resignation as a director of the Issuer, he owned stock options representing a right to purchase an aggreagate total of 40,000 shares of the Issuer's common stock, at exercises prices ranging from $0.45 to $3.00 per share. |
Remarks: |
Mr. Shaffer ceased to be a director as of November 15, 2006. This Form 4 is filed for the sole purpose of notifying the public that Mr. Shaffer is exiting from the Section 16 reporting system. |
/s/ Gary Shaffer | 11/16/2006 | |
** 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. |