-----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, GBGaZ3YiBUnea8V5+3WjeXvx6HQuEjjgbJNhVOE7Np8xaSLlawFNtaBOIT8bgJeU d5xSpNZMkWPQhU7Le6jYrg== 0001179110-03-010812.txt : 20031114 0001179110-03-010812.hdr.sgml : 20031114 20031114182030 ACCESSION NUMBER: 0001179110-03-010812 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031112 FILED AS OF DATE: 20031114 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PETERS BRADFORD G CENTRAL INDEX KEY: 0001212863 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-11064 FILM NUMBER: 031006308 MAIL ADDRESS: STREET 1: C/O BLACKFIN CAPITAL LLC STREET 2: 622 THIRD AVE 38TH FL CITY: NEW YORK STATE: NY ZIP: 10017 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BRITESMILE INC CENTRAL INDEX KEY: 0000866734 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HEALTH SERVICES [8000] IRS NUMBER: 870410364 STATE OF INCORPORATION: UT FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 490 NORTH WIGET LANE CITY: WALNUT CREEK STATE: CA ZIP: 94598 BUSINESS PHONE: 9259416260 MAIL ADDRESS: STREET 1: 490 NORTH WIGET LANE CITY: WALNUT CREEK STATE: CA ZIP: 94598 FORMER COMPANY: FORMER CONFORMED NAME: ION LASER TECHNOLOGY INC DATE OF NAME CHANGE: 19930328 4 1 edgar.xml FORM 4 - X0201 4 2003-11-12 0 0000866734 BRITESMILE INC BSML 0001212863 PETERS BRADFORD G C/O BLACKFIN CAPITAL 622 THIRD AVENUE, 38TH FLOOR NEW YORK CITY NY 10017 1 0 0 0 Common Stock 2003-11-12 4 C 0 169991 6.00 A 283630 D Convertible Note 6.00 2003-11-12 4 C 0 1 1000000 D 2002-11-20 2005-11-20 Common Stock 169991 53757 D Convertible promissory note in the principal amount of $1,000,000 plus accrued interest in the amount of $19,944 converted to 169,991 shares of common at conversion price of $6.00 per share Bradford G. Peters 2003-11-13 -----END PRIVACY-ENHANCED MESSAGE-----