Prourocare Medical Inc. - Statement of Changes in Beneficial Ownership (4)
July 15 2008 - 5:40PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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(f) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Smith Scott E
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2. Issuer Name
and
Ticker or Trading Symbol
ProUroCare Medical Inc.
[
PRRC
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
_____ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Last)
(First)
(Middle)
10513 RIGBY DR.
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3. Date of Earliest Transaction
(MM/DD/YYYY)
7/11/2008
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(Street)
EDEN PRAIRIE, MN 55437
(City)
(State)
(Zip)
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4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock, $0.00001 par value
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7/11/2008
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P
(9)
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6250
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A
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$1
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24746
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D
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Common stock, $0.00001 par value
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7/11/2008
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J
(8)
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10000
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A
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$1
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34746
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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. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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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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Stock Options
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$7.00
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(1)
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5/30/2013
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Common Stock, $0.00001 par value
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3000
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3000
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D
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Warrants
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(2)
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(3)
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12/31/2012
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Common Stock, $0.00001 par value
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7000
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7000
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D
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Convertible Promissory Notes
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(4)
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(6)
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6/27/2009
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Common stock, $0.00001 par value
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(5)
(7)
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$3325
(5)
(7)
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D
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Explanation of Responses:
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(
1)
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Immediately exercisable.
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(
2)
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Each warrant is exercisable into common stock at 50% of the per share price of equity securities issued in a public offering. in the event that ProUroCare Medical Inc. fails to close a public offering prior to June 27, 2009, each warrant will be exercisable at 50% of the closing price of ProUroCare Medical Inc.'s common stock on that date.
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(
3)
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Each of the warrants will become exercisable upon the earlier of the closing of an underwritten public offering or June 27, 2009.
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(
4)
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The Notes and any accrued interest thereon are convertible into common stock at 70% of the per share price of equity securities issued in a public offering. In the event that ProUroCare Medical Inc. fails to close a public offering prior to June 27, 2009, the Notes and any accrued interest thereon will be convertible into common stock at $0.05 per share.
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(
5)
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The number of shares that the notes are convertible into depends upon the converion price that is to be determined at the time of an underwritten public offering. If ProUroCare Medical Inc. fails to close on an underwritten public offering by June 27, 2009 and fails to prepay the notes, the notes will be convertible into 665,000 shares of common stock.
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(
6)
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The notes are convertible into common stock upon the closing of an underwritten public offering of equity securities by ProUroCare Medical Inc.
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(
7)
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Principal amount. Interest accrues at 10%, and is convertible into common stock as well.
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(
8)
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Issued to reporting person in recognition of extraordinary time and effort spent of the Company's restructuring and refinancing since January 2007.
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(
9)
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Issued to reporting person in lieu of cash for accrued director's fees.
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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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Smith Scott E
10513 RIGBY DR.
EDEN PRAIRIE, MN 55437
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X
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Signatures
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Richard B. Thon by power of attorney
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7/14/2008
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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 4(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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