UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Employee Stock Option (right to buy) | Â (2) | 11/16/2010 | Common Stock | 3,334 (3) | $ 0.45 | D | Â |
Employee Stock Option (right to buy) | Â (4) | 09/19/2012 | Common Stock | 16,250 (5) | $ 0.45 | D | Â |
Employee Stock Option (right to buy) | Â (6) | 04/03/2013 | Common Stock | 13,750 (7) | $ 0.45 | D | Â |
Employee Stock Option (right to buy) | Â (8) | 05/20/2014 | Common Stock | 30,000 | $ 1.9 | D | Â |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Buckman Pamela M C/O THERMAGE, INC. 25881 INDUSTRIAL BOULEVARD HAYWARD, CA 94545 |
 |  |  VP Clinical & Reg Affairs |  |
/s/ Pamela M. Buckman | 11/09/2006 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | These reported securities are owned directly by The David Schlerf and Pamela Buckman Revocable Trust fbo David Schlerf and Pamela Buckman and their issue under instrument dated August 16, 1991 and indirectly by Pamela Buckman, as trustees of the aforementioned trust, and Ms. Buckman disclaims beneficial ownership of these securities except to the extent of their pecuniary interests therein. |
(2) | This option vests and the shares become exercisable according to the following schedule according to the following schedule: 1/4 on October 30, 2001 and 1/48 on the last day of each full calendar month thereafter. |
(3) | The original grant for 40,000 shares was partially exercised as follows: 36,666 shares on July 19, 2004. |
(4) | This option vests and the shares become exercisable according to the following schedule according to the following schedule: 1/48 on October 31, 2002 and 1/48 on the last day of each full calendar month thereafter. |
(5) | The original grant for 30,000 shares was partially exercised as follows: 13,125 shares on July 19, 2004 and 625 shares on July 31, 2004. |
(6) | This option vests and the shares become exercisable according to the following schedule according to the following schedule: 1/48 on May 31, 2003 and 1/48 on the last day of each full calendar month thereafter. |
(7) | The original grant for 20,000 shares was partially exercised as follows: 5,833 shares on July 19, 2004 and 417 shares on July 31, 2004. |
(8) | This option vests and the shares become exercisable according to the following schedule according to the following schedule: 1/48 on June 30, 2004 and 1/48 on the last day of each full calendar month thereafter. |
 Remarks: The Date of Event is based upon the date of effectiveness of the Issuer's Registration Statement on Form S-1 filed in connection with the Issuer's initial public offering, estimated to be on or about November 9, 2006. |