5//SEC Filing
CLARKE DAVID H 5
Accession 0000911420-05-000083
CIK 0001111697other
Filed
Feb 14, 7:00 PM ET
Accepted
Feb 15, 5:50 PM ET
Size
15.5 KB
Accession
0000911420-05-000083
Insider Transaction Report
Form 5
CLARKE DAVID H
Director10% Owner
Transactions
- Purchase
Series A Convertible Preferred Stock
2004-07-30$25000.00/sh+2$50,000→ 0 totalExercise: $1.78From: 2004-07-30→ Common Stock (28,122 underlying) - Purchase
Warrants
2004-07-30+25,000→ 0 totalExercise: $3.00From: 2004-07-30Exp: 2009-07-30→ Common Stock (25,000 underlying) - Other
Common Stock
2004-12-09−4,000,000→ 6,499,486 total(indirect: Lake Worth Ventures, Inc.) - Other
Common Stock
2004-12-09+916,400→ 916,400 total - Purchase
Common Stock
2004-12-17$0.50/sh+500,000$250,000→ 6,499,486 total(indirect: Lake Worth Ventures, Inc.) - Gift
Warrants
2004-03-16$1.54/sh+50,000$77,000→ 1,739,347 totalExercise: $1.54From: 2003-12-09Exp: 2006-12-09→ Common Stock (50,000 underlying)
Footnotes (4)
- [F1]This transaction should have been reported on Form 4.
- [F2]This transaction relates to a dividend distribution of an aggregate of 4,000,000 shares of DOBI Medical common stock to Mr. Clarke, Mr. Clarke's spouse and Mr. Clarke's adult children by Lake Worth Ventures, Inc., the record owner of such shares. Lake Worth Ventures is controlled by Mr. Clarke. Neither Mr. Clarke nor Lake Worth Ventures has retained any pecuniary or beneficial ownership interest in the DOBI Medical common stock distributed by Lake Worth Ventures, except for 916,400 shares of common stock distributed and beneficially owned by Mr. Clarke individually and 616,800 shares of common stock distributed to and owned by Janice S. Brightwell Trust FBO Mr. Clarke. Mr. Clarke disclaims beneficial ownership of 922,400 shares of DOBI Medical common stock distributed as a dividend by Lake Worth Ventures to Mr. Clarke's spouse.
- [F3]The ability to convert these securities is not subject to any expiration date.
- [F4]These warrants were issed to Mr. Clarke as part of his purchase of 2 shares of Series A Convertible Preferred Stock on July 30, 2004 at a price per share of $25,000.
Documents
Issuer
DOBI MEDICAL INTERNATIONAL INC
CIK 0001111697
Entity typeother
Related Parties
1- filerCIK 0001251818
Filing Metadata
- Form type
- 5
- Filed
- Feb 14, 7:00 PM ET
- Accepted
- Feb 15, 5:50 PM ET
- Size
- 15.5 KB