| FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/01/2005 |
3. Issuer Name and Ticker or Trading Symbol
MERGE TECHNOLOGIES INC [ MRGE ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. 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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| Table I - Non-Derivative Securities Beneficially Owned | |||
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| 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) |
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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 Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: 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 | ||||
| Stock Options | (1) | 09/12/2009 | Common Stock | 706,458 | 1.43 | D | |
| Exchangeable Non-Voting Shares | (2) | (3) | Common Stock | 145,181 | 0.00 | D | |
| Explanation of Responses: |
| 1. Options to purchase 293,500 shares of Common Stock on June 1, 2005; 146,750 options to purchase shares of Common Stock on each of September 13, 2005 and September 13, 2006; and 119,458 options to purchase shares of Common Stock vesting on September 13, 2007. |
| 2. Exchangeable Non-Voting Shares, no par value, of Merge Cedara ExchangeCo Limited, an indirectly wholly owned subsidiary of Merge Technologies Incorporated, exchangeable on a one-to-one basis for the Common Stock, par value of $0.01 per share, of Merge Technologies Incorporated, exchangeable at any time prior to an autotomatic conversion, in accordance with the terms and conditions of the Merger Agreement entered into on January 17, 2005, by and among Merge Technologies Incorporated, Corrida, Ltd., now known as Merge Cedara ExchangeCo Limited, and Cedara Software Corp. |
| 3. Exchangeable Non-Voting Shares, no par value, of Merge Cedara ExchangeCo Limited, an indirectly wholly owned subsidiary of Merge Technologies Incorporated, exchangeable on a one-to-one basis for the Common Stock, par value of $0.01 per share, of Merge Technologies Incorporated, with automatic conversion rights in accordance with the Merger Agreement entered into on January 17, 2005, by and among Merge Technologies Incorporated, Corrida, Ltd., now known as Merge Cedara ExchangeCo Limited, and Cedara Software Corp. |
| Remarks: |
| /s/ Julie Ann B. Schumitsch, by Power of Attorney for Abe Schwartz | 06/07/2005 | |
| ** 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 Number. | ||