SEC FORM
4
SEC Form 4
FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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2. Issuer Name and Ticker or Trading Symbol
EnteroMedics Inc
[ ETRM ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
X |
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year) 11/15/2007
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Form filed by One Reporting Person |
X |
Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction 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 |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
11/15/2007 |
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P |
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187,500 |
A |
$8
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187,500 |
D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction 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
(Month/Day/Year) |
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: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Series C Preferred Stock |
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Common Stock |
1,359,261 |
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1,359,261 |
D
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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1. Name and Address of Reporting Person*
2710 SAND HILL RD |
2ND FLOOR |
(Street)
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Explanation of Responses: |
Remarks: |
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/s/ Michael B. Sweeney, Managing Director |
11/15/2007 |
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/s/ Harvey B. Cash by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ Philip T. Gianos by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ W. Stephen Holmes by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ Gilbert H. Kliman by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ Arnold L. Oronsky by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ Thomas L. Rosch by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ Michael B. Sweeney by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ Michael D. Boich by Karen A. Wilson Power of Attorney |
11/15/2007 |
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/s/ Bruce A. Cleveland by Karen A. Wilson Power of Attorney |
11/15/2007 |
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** 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
4
(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 Number. |
Exhibit 99
Exhibit 99
FORM 4 JOINT FILER INFORMATION
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Name of |
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Reporting Persons:
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InterWest Partners IX, L.P. (IW9) |
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InterWest Management Partners IX, LLC (IMP9) |
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Harvey B. Cash |
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Philip T. Gianos |
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W. Stephen Holmes |
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Gilbert H. Kliman |
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Arnold L. Oronsky |
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Thomas L. Rosch |
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Michael B. Sweeney |
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Michael D. Boich |
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Bruce A. Cleveland |
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Christopher B. Ehrlich |
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Linda S. Grais |
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Nina Kjellson |
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H. Ronald Nash |
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Khaled A. Nasr |
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Douglas A. Pepper |
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Victor A. Westerlind |
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Address:
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2710 Sand Hill Road, Second Floor |
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Menlo Park, CA 94025 |
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Designated Filer:
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InterWest Partners IX, L.P. |
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Issuer and Ticker Symbol:
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EnteroMedics Inc. (ETRM) |
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Date of Event:
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November 15, 2007 |
Each of the following is a Joint Filer with InterWest Partners IX L.P. (IW9) and may be deemed to
share indirect beneficial ownership in the securities set forth on the attached Form 4:
InterWest Management Partners IX, LLC (IMP9) is the general partner of IW9 and has sole voting
and investment control over the shares owned by IW9. Harvey B. Cash, Philip T. Gianos, W. Stephen
Holmes, Gilbert H. Kliman, Arnold L. Oronsky, Thomas L. Rosch, and Michael B. Sweeney are Managing
Directors of IMP9 and Michael D. Boich, Bruce A. Cleveland, Christopher B. Ehrlich, Linda S. Grais,
Nina Kjellson, H. Ronald Nash, Khaled A. Nasr, Douglas A. Pepper, and Victor A. Westerlind are
Venture Members of IMP9. Ellen Koskinas, a Venture Member of IMP9 is also a Director of the Issuer,
and has filed a separate Form 4 in her own name.
All Reporting Persons disclaim beneficial ownership of shares of EnteroMedics Inc. stock held by
IW9, except to the extent of their respective pecuniary interest therein. The filing of this
statement shall not be deemed an admission that, for purposes of Section 16 of the Securities
Exchange Act of 1934, or otherwise, any of the Reporting Persons are the beneficial owner of all of
the equity securities covered by this statement.
1.
Exhibit 99
Each of the Reporting Persons listed above has designated InterWest Partners IX, L.P. as its
designated filer of Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange
Act of 1934 and the rules thereunder. Each Reporting Person has appointed InterWest Management
Partners IX, LLC as its attorney in fact for the purpose of making reports relating to transaction
in EnteroMedics Inc. Common Stock.
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InterWest Management Partners IX, L.L.C. |
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Thomas L. Rosch, an individual |
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact |
By:
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/s/ Michael B. Sweeney |
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Michael B. Sweeney, Managing Director
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney |
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InterWest Partners IX, LP |
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Michael B. Sweeney, an individual |
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By:
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InterWest Management Partners IX, LLC, |
By:
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InterWest Management Partners IX, LLC
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as Attorney-in-Fact |
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Its General Partner |
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney |
By:
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/s/ Michael B. Sweeney |
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Michael B. Sweeney, Managing Director |
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Harvey B. Cash, an individual |
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Michael D. Boich, an individual |
By:
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InterWest Management Partners IX, LLC,
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney
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Karen A. Wilson, Power of Attorney |
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Philip T. Gianos, an individual |
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Bruce A. Cleveland, an individual |
By:
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InterWest Management Partners IX, LLC,
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney
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Karen A. Wilson, Power of Attorney |
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W. Stephen Holmes, an individual |
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Christopher B. Ehrlich, an individual |
By:
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InterWest Management Partners IX, LLC,
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney
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Karen A. Wilson, Power of Attorney |
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Gilbert H. Kliman, an individual |
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Linda S. Grais, an individual |
By:
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InterWest Management Partners IX, LLC,
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney
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Karen A. Wilson, Power of Attorney |
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Arnold L. Oronsky, an individual |
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Nina Kjellson, an individual |
By:
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InterWest Management Partners IX, LLC,
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney
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Karen A. Wilson, Power of Attorney |
2.
Exhibit 99
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H. Ronald Nash, an individual |
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney |
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Khaled A. Nasr, an individual |
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney |
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Douglas A. Pepper, an individual |
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney |
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Victor A. Westerlind, an individual |
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By:
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InterWest Management Partners IX, LLC, |
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as Attorney-in-Fact |
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By:
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/s/ Karen A. Wilson |
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Karen A. Wilson, Power of Attorney |
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3.