| 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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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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
THERASENSE INC [ THER ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 04/05/2004 | ||||||||||||||||||||||||||
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4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock | 04/05/2004 | D | 3,237,103 | D | $27(4) | 0 | I | By: InterWest Partners VI, LP(1) | ||
| Common Stock | 04/05/2004 | D | 101,494 | D | $27(4) | 0 | I | By: InterWest Investors VI, LP(1) | ||
| Common Stock | 04/05/2004 | D | 100,306 | D | $27(4) | 0 | I | By: InterWest Partners V, LP(2) | ||
| Common Stock | 04/05/2004 | D | 27,647 | D | $27(4) | 0 | I | By: The Momsen Living Trust U/A/D 1-5-95(3) | ||
| Common Stock | 04/05/2004 | D | 175,000 | D | $27(4) | 0 | I | By: InterWest Venture Mgmt Co. PSRP FBO Robert R. Momsen | ||
| Common Stock | 04/05/2004 | D | 1,000 | D | $27(4) | 0 | I | By: Robert Momsen Custodian FBO Paige Momsen under CA uniform TFR to Minor | ||
| Common Stock | 04/05/2004 | D | 1,000 | D | $27(4) | 0 | I | By: Robert Momsen Custodian FBO Nick Momsen under CA uniform TFR to Minor | ||
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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) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| NQ option (right to buy) | $5 | 04/05/2004 | D | 30,000 | (5) | 09/28/2010 | Common | 30,000 | $22 | 0 | D | ||||
| NQ option (right to buy) | $21.25 | 04/05/2004 | D | 5,000 | (6) | 04/18/2012 | Common | 5,000 | $5.75 | 0 | D | ||||
| NQ option (right to buy) | $9.05 | 04/05/2004 | D | 5,000 | (6) | 05/08/2013 | Common | 5,000 | $17.95 | 0 | D | ||||
| Explanation of Responses: |
| 1. InterWest Management Partners VI, LLC has sole voting and investment control over the shares held by InterWest Partners VI, L.P. and InterWest Investors VI, L.P. The reporting person is a managing director of InterWest Management Partners VI, LLC, and shares voting and investment control of the shares held by the fund. The reporting person disclaims beneficial ownership of these shares except to the extent of his 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, the reporting person is the beneficial owner of all of the equity securities covered by this statement. |
| 2. InterWest Management Partners V, L.P. has sole voting and investment control over the shares held by InterWest Partners V, L.P. The reporting person is a general partner of InterWest Management Partners V, L.P., and shares voting and investment control of the shares held by the fund. The reporting person disclaims beneficial ownership of these shares except to the extent of his 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, the reporting person is the beneficial owner of all of the equity securities covered by this statement. |
| 3. The shares are held in the name of The Momsen Living Trust U/A/D 1-5-95 of which Robert Momsen is the Trustee. |
| 4. Disposed of pursuant to a merger agreement between the issuer, Abbott Laboratories and a wholly-owned subsidiary of Abbott Laboratories. |
| 5. This option vests over a three year period and was cancelled pursuant to the merger agreement between the issuer, Abbott Laboratories and a wholly-owned subsidiary of Abbott Laboratories in exchange for a cash payment per underlying share equal to $27.00 less the exercise price. |
| 6. This option vests on the one-year anniversary from the date of grant and was cancelled pursuant to the merger agreement between the issuer, Abbott Laboratories and a wholly-owned subsidiary of Abbott Laboratories in exchange for a cash payment per underlying share equal to $27.00 less the exercise price. |
| /s/ Robert R. Momsen | 04/05/2004 | |
| ** 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. | ||