Statement of Changes in Beneficial Ownership (4)
02 8월 2016 - 8:26AM
Edgar (US Regulatory)
FORM 4
[
X
]
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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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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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
*
Schuler Family Foundation
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2. Issuer Name
and
Ticker or Trading Symbol
HANSEN MEDICAL INC
[
HNSN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
_____ Officer (give title below)
__
X
__ Other (specify below)
Former 10% Owner
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(Last)
(First)
(Middle)
C/O CRABTREE PARTNERS LLC, 100 N FIELD DRIVE STE 360
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3. Date of Earliest Transaction
(MM/DD/YYYY)
7/27/2016
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(Street)
LAKE FOREST, IL 60045
(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)
___ 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
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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, par value $0.0001 per share
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7/27/2016
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D
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4966983
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D
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$4.00
(1)
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0
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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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Explanation of Responses:
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(
1)
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Each Reporting Person received cash consideration in the amount of $4.00 per share of common stock of the Issuer that was disposed of pursuant to that certain Agreement and Plan of Merger by and among the Issuer, Auris Surgical Robotics, Inc., a Delaware corporation, and Pineco Acquisition Corp., a Delaware corporation and wholly-owned subsidiary of Pineco Acquisition Corp., dated as of April 19, 2016.
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Remarks:
(1) This Form 4 is being filed on behalf of Jack W. Schuler Living Trust and the Schuler Family Foundation (each of the foregoing, a "Reporting Person" and collectively, the "Reporting Persons"), with respect to shares of Common Stock, par value $0.001 per share, of Hansen Medical, Inc., a Delaware corporation (the "Common Stock") held in the respective accounts of the Reporting Persons.
(2) The Reporting Persons have ceased to be 10% "beneficial owners" of the Common Stock for purposes of Section 16(a), pursuant to Rule 16a-1(a)(1).
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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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Schuler Family Foundation
C/O CRABTREE PARTNERS LLC
100 N FIELD DRIVE STE 360
LAKE FOREST, IL 60045
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Former 10% Owner
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Jack W. Schuler Living Trust
C/O CRABTREE PARTNERS LLC
100 N FIELD DRIVE STE 360
LAKE FOREST, IL 60045
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Former 10% Owner
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Signatures
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Jack W. Schuler Living Trust; /s/ Jack Schuler, Trustee
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7/28/2016
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**
Signature of Reporting Person
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Date
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Schuler Family Foundation; /s/ Jack Schuler, Director
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7/28/2016
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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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