Mako Surgical Corp. - Initial Statement of Beneficial Ownership (3)
15 2월 2008 - 2:23AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
Expires:
January 31, 2008
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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(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
BRUNK GERALD A
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2. Date of Event Requiring Statement (MM/DD/YYYY)
2/14/2008
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3. Issuer Name
and
Ticker or Trading Symbol
MAKO Surgical Corp. [MAKO]
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(Last)
(First)
(Middle)
C/O LUMIRA CAPITAL CORP., 245 FIRST STREET, SUITE 1800
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4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__
X
__ Director
___
X
___ 10% Owner
_____ Officer (give title below)
_____ Other (specify below)
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(Street)
CAMBRIDGE, MA 02142
(City)
(State)
(Zip)
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5. 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 Beneficially Owned
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1.Title of Security
(Instr. 4)
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2. Amount of Securities Beneficially Owned
(Instr. 4)
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3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
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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 Derivate Security
(Instr. 4)
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2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
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3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
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4. Conversion or Exercise Price of Derivative Security
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5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
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6. Nature of Indirect Beneficial Ownership
(Instr. 5)
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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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Series B Convertible Preferred Stock
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7/14/2005
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(1)
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Common Stock
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770358
(1)
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(1)
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I
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By Lumira Capital I Limited Partnership
(2)
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Series B Convertible Preferred Stock
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7/14/2005
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(1)
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Common Stock
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271412
(1)
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(1)
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I
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By MDS Life Sciences Technology Fund II Quebec Limited Partnership
(3)
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Series B Convertible Preferred Stock
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7/14/2005
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(1)
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Common Stock
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208354
(1)
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(1)
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I
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By MLII Co-Investment Fund NC Limited Partneship
(4)
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Series C Convertible Preferred Stock
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2/6/2007
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(1)
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Common Stock
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274830
(1)
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(1)
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I
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By Lumira Capital I Limited Partnership
(2)
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Series C Convertible Preferred Stock
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2/6/2007
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(1)
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Common Stock
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96828
(1)
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(1)
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I
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By MDS Life Sciences Technology Fund II Quebec Limited Partnership
(3)
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Series C Convertible Preferred Stock
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2/6/2007
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(1)
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Common Stock
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74331
(1)
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(1)
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I
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By MLII Co-Investment Fund NC Limited Partneship
(4)
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Explanation of Responses:
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(
1)
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The convertible preferred stock has no expiration date. As a result of a one-for-3.03 reverse split of MAKO Surgical Corp. common stock, each share of convertible preferred stock is convertible into .330033 of a share of common stock. Accordingly, upon the closing of the issuer's initial public offering, the convertible preferred stock will convert into the number of shares of common stock set forth in Column 3.
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(
2)
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Lumira Capital Management Corp. ("Lumira Management"), a subsidiary of Lumira Capital Corp., is a party to a management agreement with Lumira Capital I Limited Partnership (formerly known as MDS Life Sciences Technology Fund II NC Limited Partnership). The reporting person is the Senior Vice President/Managing Director of Lumira Capital Corp., but he disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
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(
3)
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Lumira Management provides services to MDS Life Sciences Technology Fund II Quebec Limited Partnership. The reporting person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
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(
4)
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Lumira Management provides services to MLII Co-Investment Fund NC Limited Partnership. The reporting person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
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Remarks:
Exhibit List
Exhibit 24 - Power of Attorney
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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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BRUNK GERALD A
C/O LUMIRA CAPITAL CORP.
245 FIRST STREET, SUITE 1800
CAMBRIDGE, MA 02142
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X
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X
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Signatures
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/s/Menashe R. Frank, attorney in fact
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2/14/2008
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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 5(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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Mako Surgical Corp. (MM) (NASDAQ:MAKO)
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