-----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, UnkfxhkN2+3pHO4XMQT2js7/QvxoRctnro3Znm3r2poh2v9hABLWHRkWER63ZydO vHUWhCQgusEeo4sq2Fif1w== 0001179110-05-015576.txt : 20050804 0001179110-05-015576.hdr.sgml : 20050804 20050804160339 ACCESSION NUMBER: 0001179110-05-015576 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050802 FILED AS OF DATE: 20050804 DATE AS OF CHANGE: 20050804 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: NeuroMetrix, Inc. CENTRAL INDEX KEY: 0001289850 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 043308180 FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 62 FOURTH AVENUE CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: (781) 890-9989 MAIL ADDRESS: STREET 1: 62 FOURTH AVENUE CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LAVERACK WILLIAM JR CENTRAL INDEX KEY: 0001239598 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-50856 FILM NUMBER: 05999490 BUSINESS ADDRESS: STREET 1: WHITNEY & CO. STREET 2: 177 BROAD STREET CITY: STAMFORD STATE: CT ZIP: 06901 4 1 edgar.xml FORM 4 - X0202 4 2005-08-02 0 0001289850 NeuroMetrix, Inc. NURO 0001239598 LAVERACK WILLIAM JR 177 BROAD STREET, 15TH FLOOR STAMFORD CT 06901 1 0 1 0 Common Stock 2005-08-02 4 J 0 781177 0 D 2380487 I See footnote 1. Common Stock 2005-08-02 4 J 0 18823 0 D 57360 I See footnote 2. Common Stock 2005-08-03 4 J 0 95964 0 D 0 I See footnote 3. Common Stock 2005-08-02 4 A 0 33631 0 A 33631 D Common Stock 2005-08-03 4 A 0 26690 0 A 60321 D Shares owned by J. H. Whitney III, L.P. The undersigned is a member of J. H. Whitney Equity Partners III, L.L.C., the general partner of J. H. Whitney III, L.P., and has an interest in a limited partner of J. H. Whitney III, L.P. The undersigned may be deemed to share voting and dispositive power with respect to such shares. The undersigned disclaims beneficial ownership of such shares except to the extent of his proportionate interest. Shares owned by Whitney Strategic Partners III, L.P. The undersigned is a member of J. H. Whitney Equity Partners III, L.L.C., the general partner of Whitney Strategic Partners III, L.P. The undersigned may be deemed to share voting and dispositive power with respect to such shares. The undersigned disclaims beneficial ownership of such shares except to the extent of his proportionate interest. Shares owned by Whitney & Co., LLC. The undersigned is a Managing Partner in Whitney & Co., LLC and may be deemed to share voting and dispositive power with respect to such shares. The undersigned disclaims beneficial ownership of such shares except to the extent of his proportionate interest. Securities distributed to partners of J. H. Whitney III, L.P. on a pro-rata basis in accordance with the Partnership Agreement. Securities distributed to partners of Whitney Strategic Partners III, L.P. on a pro-rata basis in accordance with the Partnership Agreement. Securities distributed to members of Whitney & Co., LLC on a pro-rata basis in accordance with its governing agreement. The undersigned received 33,506 shares of Common Stock from J. H. Whitney III, L.P.and 125 shares of Common Stock from Whitney Strategic Partners III, L.P. The undersigned received 26,690 shares of Common Stock from Whitney & Co., LLC. WILLIAM LAVERACK, JR., By: Daniel J. O'Brien, Attorney-in-Fact 2005-08-04 -----END PRIVACY-ENHANCED MESSAGE-----