- Initial Statement of Beneficial Ownership (3)
08 April 2011 - 7:23AM
Edgar (US Regulatory)
FORM 3
|
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0104
Expires:
February 28, 2011
Estimated average burden
hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
Estate of Lord Leonard Steinberg
|
2. Date of Event Requiring Statement (MM/DD/YYYY)
4/7/2011
|
3. Issuer Name
and
Ticker or Trading Symbol
MEDGENICS, INC. [NONE]
|
(Last)
(First)
(Middle)
20 CARRWOOD
|
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
|
(Street)
HALEBARNS CHESHIRE, X0 WA15 0EE
(City)
(State)
(Zip)
|
5. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
|
Table I - Non-Derivative Securities Beneficially Owned
|
1.Title of Security
(Instr. 4)
|
2. Amount of Securities Beneficially Owned
(Instr. 4)
|
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
|
4. Nature of Indirect Beneficial Ownership
(Instr. 5)
|
Common Stock
|
544028
|
D
|
|
Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security
(Instr. 4)
|
2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
|
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
|
4. Conversion or Exercise Price of Derivative Security
|
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
|
6. Nature of Indirect Beneficial Ownership
(Instr. 5)
|
Date Exercisable
|
Expiration Date
|
Title
|
Amount or Number of Shares
|
Common Stock Warrants
|
5/31/2007
|
5/31/2012
|
Common Stock
|
32741
|
$5.74
|
D
|
|
Common Stock Warrants
|
12/4/2007
|
12/4/2012
|
Common Stock
|
21828
|
$5.74
|
D
|
|
Common Stock Warrants
|
12/4/2007
|
12/4/2012
|
Common Stock
|
23783
|
$6.79
|
D
|
|
Common Stock Warrants
|
1/30/2009
|
1/30/2012
|
Common Stock
|
12857
|
$8.75
|
D
|
|
2009 Convertible Debentures
|
6/16/2009
|
(1)
|
Common Stock
|
(1)
|
(1)
|
D
|
|
2009 Convertible Debentures
|
8/31/2009
|
(2)
|
Common Stock
|
(2)
|
(2)
|
D
|
|
Explanation of Responses:
|
(
1)
|
The $70,000 Convertible Debenture is convertible into shares of common stock of Medgenics, Inc. at the option of the holder
at any time at $4.20 per share and shall be automatically converted into common stock upon the closing of the issuer's
initial public offering at a conversion price that is related to the price that the issuer's common stock is sold in such
initial public offering and therefore currently not determined. The Convertible Debenture has no stated expiration date.
|
(
2)
|
The $100,000 Convertible Debenture is convertible into shares of common stock of Medgenics, Inc. at the option of the holder
at any time at $4.20 per share and shall be automatically converted into common stock upon the closing of the issuer's
initial public offering at a conversion price that is related to the price that the issuer's common stock is sold in such
initial public offering and therefore currently not determined. The Convertible Debenture has no stated expiration date.
|
Reporting Owners
|
Reporting Owner Name / Address
|
Relationships
|
Director
|
10% Owner
|
Officer
|
Other
|
Estate of Lord Leonard Steinberg
20 CARRWOOD
HALEBARNS CHESHIRE, X0 WA15 0EE
|
|
X
|
|
|
Signatures
|
/s/ Sarah Hoffman, Attorney-in-Fact
|
|
4/7/2011
|
**
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 5(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 control number.
|
Aevi Genomic Medicine (NASDAQ:GNMX)
Historical Stock Chart
From Sep 2024 to Oct 2024
Aevi Genomic Medicine (NASDAQ:GNMX)
Historical Stock Chart
From Oct 2023 to Oct 2024
Real-Time news about Aevi Genomic Medicine Inc (NASDAQ): 0 recent articles
More News Articles