-----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, EiyC/P71UM7oJ/Olzdg/d62JZ0EOsnuH5dKO4POsbn7slxl18fGgbaI3xs5HaV3R TUHjzL4AzTgwI4RjzKC8cw== 0001134619-09-000003.txt : 20091207 0001134619-09-000003.hdr.sgml : 20091207 20091207130700 ACCESSION NUMBER: 0001134619-09-000003 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20091019 FILED AS OF DATE: 20091207 DATE AS OF CHANGE: 20091207 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: BioDrain Medical, Inc. CENTRAL INDEX KEY: 0001446159 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 331007393 STATE OF INCORPORATION: MN FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2060 CENTRE POINTE BOULEVARD STREET 2: SUITE 7 CITY: MENDOTA HEIGHTS STATE: MN ZIP: 55120 BUSINESS PHONE: (612) 850-9460 MAIL ADDRESS: STREET 1: 2060 CENTRE POINTE BOULEVARD STREET 2: SUITE 7 CITY: MENDOTA HEIGHTS STATE: MN ZIP: 55120 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DAUWALTER JAMES E CENTRAL INDEX KEY: 0001134619 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 333-155299 FILM NUMBER: 091225603 MAIL ADDRESS: STREET 1: BIODRAIN MEDICAL INC. STREET 2: 2060 CENTRE POINTE BLVD., SUITE 7 CITY: MENDOTA HEIGHTS STATE: MN ZIP: 55120 3 1 primary_doc.xml PRIMARY DOCUMENT X0203 3 2009-10-19 0 0001446159 BioDrain Medical, Inc. BIOR 0001134619 DAUWALTER JAMES E BIODRAIN MEDICAL INC. 2060 CENTRE POINTE BLVD., SUITE 7 MENDOTA HEIGHTS MN 55120 1 0 0 0 Common Stock 771429 D Common Stock 50000 I By Familial Relationship Option to purchase common stock 0.35 2008-08-11 2013-08-11 Common Stock 10000 I By Familial Relationship Option to purchase common stock 0.35 2009-04-15 2013-08-11 Common Stock 10000 I By Familial Relationship Option to purchase common stock 0.35 2009-05-30 2013-08-11 Common Stock 10000 I By Familial Relationship Option to purchase common stock 0.35 2013-08-11 Common Stock 20000 I By Familial Relationship Warrant to purchase common stock 0.46 2008-08-02 2011-07-02 Common Stock 571429 D Warrant to purchase common stock 0.65 2009-04-30 2012-04-29 Common Stock 200000 D These shares are held by David Dauwalter, the adult son of James Dauwalter and an employee of BioDrain Medical, Inc. James Dauwalter disavows any beneficial interest in the shares. The option shares are held by David Dauwalter, the adult son of James Dauwalter and an employee of BioDrain Medical, Inc. James Dauwalter disavows any beneficial interest in the shares. Exercisable only upon achieving certain performance conditions and are, therefore, not exercisable within 60 days. /s/ James Dauwalter 2009-12-02 -----END PRIVACY-ENHANCED MESSAGE-----