SEC Form 4 · accession 0001235802-15-000008
Kips Bay Medical, Inc. · KIPS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Scott Kellen
Officer — COO, CFO, VP of Finance & Secy
Period of report
Jan 5, 2015
Accepted (ET)
Jan 6, 2015 · 4:26 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001460198
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | holding | — | — | — | 20,000 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy) | $0.18 | Jan 5, 2015 | A | 50,000 | A | Jan 5, 2016 | Jan 5, 2025 | Common Stock | 50,000 | 50,000 | D |