FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 01/17/2012 |
3. Issuer Name and Ticker or Trading Symbol
CAMBRIDGE HEART INC [ CAMH ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 3,759,147 | I | See Footnote(1) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series D Convertible Preferred Stock | (2) | (2) | Common Stock | 3,292,683 | $0.082 | I | See Footnote(1) |
Senior Secured Convertible Promissory Notes | 01/17/2012 | 01/17/2013 | Common Stock | 1,545,454 | $0.11(3) | I | See Footnote(1) |
Common Stock Warrants | 12/20/2010 | 12/20/2015 | Common Stock | 1,125,000 | $0.25 | I | See Footnote(1) |
Common Stock Warrants | 01/17/2012 | 01/17/2016 | Common Stock | 1,545,454 | $0.15(4) | I | See Footnote(1) |
Additional Investment Right | 01/17/2012 | 07/15/2012 | Common Stock | 772,726 | (5) | I | See Footnote(1) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. The securities reported herein are held by Osiris Investment Partners, L.P. ("Osiris LP"), an investment fund for which Osiris Partners, LLC ("Osiris LLC") serves as general partner. Mr. Stuka serves as managing member of Osiris LLC. In such capacities, Osiris LLC and Mr. Stuka may be deemed to beneficially own the reported securities. Mr. Stuka, Osiris LLC and Osiris LP each disclaims beneficial ownership of the reported securities except to the extent of his or its pecuniary interest therein, and the inclusion of such securities in this report shall not be deemed an admission of beneficial ownership for purposes of Section 16 or for any other purpose. |
2. Osiris LP owns 270,000 shares of Series D Convertible Preferred Stock of the Company. Each share of the Series D Convertible Preferred Stock is convertible into a number of shares of the Company's Common Stock equal to $1,000 divided by the conversion price, which is $0.082 per common share. |
3. The conversion price of the Senior Secured Convertible Promissory Notes (the "Notes") is subject to adjustment in certain circumstances. If the Company issues shares of common stock, or securities convertible into or exercisable for shares of common stock, at a price lower than the conversion price, then the conversion price of the Notes will, with limited exceptions, be adjusted to such lower price. |
4. The exercise price of the Common Stock Warrants (the "Warrants") is subject to adjustment in certain circumstances. If the Company issues shares of common stock, or securities convertible into or exercisable for shares of common stock, at a price lower than the exercise price, then the exercise price of the Warrants will, with limited exceptions, be adjusted to such lower price. |
5. The Additional Investment Rights ("AIRs") grant Osiris LP the right to purchase additional Notes having an aggregate principal amount equal to 25% of the principal amount of the Notes originally purchased by Osiris LP and a corresponding number of Warrants. Upon exercise of the AIRs, Osiris LP would acquire additional Notes that could be converted into 386,363 shares of the Company's Common Stock and additional Warrants that could be exercised for 386,363 shares of the Company's Common Stock, upon the terms described in Footnotes 3 and 4, respectively. |
Remarks: |
/s/ Osiris Partners, LLC, by Paul Stuka, its managing member | 01/27/2012 | |
/s/ Osiris Investment Partners, L.P., by Osiris Partners, LLC, its general partner, by Paul Stuka, its managing member | 01/27/2012 | |
/s/ Paul Stuka | 01/27/2012 | |
** 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 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). | ||
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. |