-----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, NLfbD/ngJzngrFup3lkEXZUZXfciJvF5PJXIoCcgW8j1/vGx3Tx90QnF7DQouhoA kUhv/pWB253bTsux/+8BRg== 0001134619-11-000001.txt : 20110106 0001134619-11-000001.hdr.sgml : 20110106 20110106160915 ACCESSION NUMBER: 0001134619-11-000001 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20100113 FILED AS OF DATE: 20110106 DATE AS OF CHANGE: 20110106 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 333-155299 FILM NUMBER: 11514396 MAIL ADDRESS: STREET 1: BIODRAIN MEDICAL INC. STREET 2: 2060 CENTRE POINTE BLVD., SUITE 7 CITY: MENDOTA HEIGHTS STATE: MN ZIP: 55120 4 1 primary_doc.xml PRIMARY DOCUMENT X0303 4 2010-01-13 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 Convertible note due 2012 2010-01-13 4 P 0 0 A 0 D Common stock 2010-05-27 4 A 0 89143 A 910572 D Common stock 2010-11-16 4 A 0 75000 0 A 985572 D Options 0.15 2010-11-16 4 A 0 325000 0 A 2010-11-16 2020-11-16 Common stock 325000 325000 I Son This security was issued with a $50,000 principal amount by the Issuer in exchange for $50,000 in cash consideration. The conversion price is not fixed and floats based on the market price on the underlying common stock - specifically, the security converts at 50% of the average closing price of the Issuer's common stock during the 10-day period prior to conversion. The issuer granted these securities to the reporting person as a penalty for its failure to cause timely effectiveness of a registration statement on Form S-1. This stock award vests 100% upon the earlier of a change in control, average 30 day trading volume of 50,000 shares, or 6 consecutive quarters of not less than $150,000 in net income recognized by the issuer. If none of these events occur within 10 years of the grant date, then the stock is forfeited. This security was granted to David Dauwalter, the adult son of the reporting person and an employee of the Issuer. The reporting person disavows any beneficial interest in the security and underlying securities. /s/ James Dauwalter 2010-12-29 -----END PRIVACY-ENHANCED MESSAGE-----