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| 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, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 | | OMB APPROVAL | | OMB Number: | 3235-0287 | | Expires: | February 28, 2011 | | Estimated average burden | | hours per response | 0.5 |
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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*
| SHINJUKU MONOLITH, 3-1 NISHI-SHINJUKU 2-CHOME | |
(Street)| SHINJUKU-KU, TOKYO | M0 | 163-0914 |
| 2. Issuer Name and Ticker or Trading Symbol CYTORI THERAPEUTICS, INC.
[CYTX] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) | Director | X | 10% Owner | | Officer (give title below) | | Other (specify below) | |
| 3. Date of Earliest Transaction (Month/Day/Year) 08/07/2008 | 4. If Amendment, Date of Original Filed (Month/Day/Year)
| 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 Acquired, Disposed of, or Beneficially Owned | 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
| 08/07/2008 | | P | |
1,000,000
| A | $
6
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4,013,043
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D
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities) | 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 Underlying Securities (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 of Derivative Security: 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 | |
Common Stock Warrant
| $
8.5
| 08/07/2008 | | P | |
500,000
| | 02/11/2009 | 08/11/2013 |
Common Stock
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500,000
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$
0
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500,000
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D
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| Explanation of Responses: | |
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| Jonathan E. Soneff, By Power of Attorney For: Olympus Corporation | 08/11/2008 | | ** 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. |
EX-24.1
Unassociated Document
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Authorization
To Sign Reportable Securities Transaction Forms
Special
Power of Attorney
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1.
Name and Address of Reporting Person
Olympus
Corporation
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2. Date
June
7, 2005
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4. Issuer
Name and Ticker or Trading Symbol
Cytori
Therapeutics, Inc. (CYTX)
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Olympus
Corporation hereby authorizes and designates Issuer’s In-House Counsel
(Currently Jonathan Soneff) power to sign and file the following forms and
related documents with the United States Securities and Exchange Commission on
behalf of Olympus Corporation relative to transactions or holdings of Issuer’s
securities:
Form ID,
Form 3, Form 4, Form 5, Schedule 13(d), Schedule 13(g) and Form
144.
This
Authorization To Sign shall be valid for a period of five (5) years or until it
is revoked.
/s/ Masaaki Terada June 7, 2005
Olympus
Corporation (Date)
Name:
Masaaki Terada
Title: Director
/ Corporate R&D Center
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