Mako Surgical Corp. - Initial Statement of Beneficial Ownership (3)
February 14 2008 - 12:34PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0104
Expires:
January 31, 2008
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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
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1. Name and Address of Reporting Person
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Ferre Maurice R
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2. Date of Event Requiring Statement (MM/DD/YYYY)
2/14/2008
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3. Issuer Name
and
Ticker or Trading Symbol
MAKO Surgical Corp. [MAKO]
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(Last)
(First)
(Middle)
C/O MAKO SURGICAL CORP., 2555 DAVIE ROAD
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
_____ 10% Owner
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X
___ Officer (give title below)
_____ Other (specify below)
President, CEO and Chairman /
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(Street)
FT. LAUDERDALE, FL 33317
(City)
(State)
(Zip)
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5. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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4. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Common Stock
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741075
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D
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Common Stock Warrants (right to buy)
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12/17/2004
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12/17/2014
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Common Stock
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5631
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$3.00
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D
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Employee Stock Option (right to buy)
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(1)
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9/5/2017
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Common Stock
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35244
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$11.1201
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D
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Series A Convertible Preferred Stock
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12/17/2004
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(2)
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Common Stock
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17065
(2)
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(2)
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D
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Explanation of Responses:
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(
1)
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Vests and becomes exercisable ratably quarterly over four years.
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(
2)
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The convertible preferred stock has no expiration date. As a result of a one-for-3.03 reverse split of MAKO Surgical Corp. common stock, each share of convertible preferred stock is convertible into .330033 of a share of common stock. Accordingly, upon the closing of the issuer's initial public offering, the convertible preferred stock will convert into the number of shares of common stock set forth in Column 3.
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Remarks:
Exhibit List
Exhibit 24 - Power of Attorney
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Ferre Maurice R
C/O MAKO SURGICAL CORP.
2555 DAVIE ROAD
FT. LAUDERDALE, FL 33317
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X
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President, CEO and Chairman
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Signatures
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/s/Menashe R. Frank, attorney in fact
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2/14/2008
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 5(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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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.
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