SEC FORM
3
SEC Form 3
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
|
OMB APPROVAL |
OMB Number: |
3235-0104 |
Estimated average burden |
hours per response: |
0.5 |
|
|
1. Name and Address of Reporting Person*
C/O HEALTHCARE VENTURES LLC |
44 NASSAU STREET |
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 08/06/2007
|
3. Issuer Name and Ticker or Trading Symbol
HEALTHCARE ACQUISITION CORP
[ HAQ ]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
X |
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
5. 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 |
|
Table I - Non-Derivative Securities Beneficially Owned |
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, $0.0001 par value per share |
3,297,174 |
I
|
By Partnership
|
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
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 |
Unsecured Convertible Note |
|
08/03/2009 |
Common Stock |
181,252 |
10 |
I
|
By Partnership |
Stock Option (Right to Buy) |
|
09/11/2013 |
Common Stock |
1,493 |
3.28 |
D |
|
Stock Option (Right to Buy) |
|
01/18/2011 |
Common Stock |
996 |
3.28 |
D |
|
Explanation of Responses: |
Remarks: |
|
S/Jeffrey Steinberg, Attorney-in-Fact for James H. Cavanaugh |
08/07/2007 |
|
** 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. |
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that each person whose signature
appears below hereby constitutes and appoints Jeffrey B. Steinberg
his true and lawful attorney-in-fact, with full power of substitution,
to sign any and all instruments, certificates and documents that may
be necessary, desirable or appropriate to be executed on behalf of
himself as an individual or in his capacity as a general partner of
any partnership, pursuant to section 13 and 16 of the Securities
Exchange Act of 1934, as amended (the "Exchange Act"), and any and
all regulations promulgated thereunder, and Rules 144, 144A and 145
under the Securities Act of 1933, as amended (the "Securities Act"),
and to file the same, with all exhibits thereto, and any other
documents in connection therewith, with the Securities and Exchange
Commission, and with any other entity when and if such is mandated
by the Exchange Act, by the Securities Act or by the By-laws of the
National Association of Securities Dealers, Inc., granting unto
said attorney-in-fact full power and authority to do and perform
each and every act and thing necessary, desirable or appropriate,
fully to all intents and purposes as he might or could do in person,
thereby ratifying and confirming all that said attorney-in-fact, or
his substitutes may lawfully do or cause to be done by virtue hereof.
IN WITNESS WHEREOF, this Power of Attorney has been signed as of the
20th day of December, 1996.
Signature: /s/ James H. Cavanaugh
Print Name: James H. Cavanaugh
Signature: /s/ John Littlechild
Print Name: John Littlechild
Signature: /s/ Harold Werner
Print Name: Harold Werner