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
TERCICA INC [ TRCA ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 03/22/2004 | ||||||||||||||||||||||||||
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 | 03/22/2004 | P | 670,000 | A | $9 | 674,997 | I | See Footnotes(1)(5) | ||
Common Stock | 03/22/2004 | C | 3,187,498 | A | $0.00 | 3,862,495 | I | See Footnotes(2)(5) | ||
Common Stock | 03/22/2004 | C | 3,199,999 | A | $0.00 | 7,062,494 | I | See Footnotes(3)(4)(5) |
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 A Convertible Preferred Stock | $0.00(6) | 03/22/2004 | C | 3,187,498 | 03/22/2004 | 03/22/2004 | Common Stock | 3,187,498 | $0.00 | 0 | I | See Footnote(2) | |||
Series B Convertible Preferred Stock | $0.00(6) | 03/22/2004 | C | 3,199,999 | 03/22/2004 | 03/22/2004 | Common Stock | 3,199,999 | $0.00 | 0 | I | See Footnote(3) |
Explanation of Responses: |
1. The shares were purchased as follows: 557,540 by MPM BioVentures III-QP, LP ("BVQP"), 37,487 by MPM BioVentures III, LP ("BVLP"), 16,844 by MPM BioVentures III Parallel Fund, LP ("BVPF"), 47,114 by MPM BioVentures GmbH & Co. Beteiligungs KG ("BVKG") and 11,015 by MPM Asset Management Investors 2002 BVIII, LLC ("BVAM"). |
2. The conversion of the Series A Convertible Preferred Stock was as follows: 2,652,475 by BVQP, 178,340 by BVLP, 80,133 by BVPF, 224,145 by BVKG and 52,405 by BVAM. |
3. The conversion of the Series B Convertible Preferred Stock was as follows: 2,662,876 by BVQP, 179,040 by BVLP, 80,448 by BVPF, 225,024 by BVKG and 52,611 by BVAM. |
4. The shares are held as follows: 5,877,051 by BVQP, 395,146 by BVLP, 177,550 by BVPF, 496,634 by BVKG and 116,113 by BVAM. |
5. MPM BioVentures III GP, LP ("BVGP") and MPM BioVentures III LLC ("BVLLC") are the indirect and direct general partners of BVQP, BVLP, BVPF and BVKG. Luke Evnin ("LE"), Ansbert Gadicke ("AG"), Nicholas Galakatos ("NG"), Dennis Henner ("DH"), Nicholas Simon III ("NS"), Michael Steinmetz ("MS") and Kurt Wheeler ("KW") are the members of BVLLC. LE, AG, NG, DH, NS, MS and KW are members of BVAM. Each member of the group disclaims beneficial ownership of the securities except to the extent of its pecuniary interest therein. |
6. Each share of preferred stock is convertible into 1 share of Common Stock. |
/s/ Dennis Henner | 03/23/2004 | |
** 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. |