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) 06/11/2009 |
3. Issuer Name and Ticker or Trading Symbol
Urigen Pharmaceuticals, Inc. [ URGP.OB ] |
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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, par value $0.001 | 564,230 | D |
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 B Prefered Stock | 07/31/2007 | 07/31/2017(1) | Common Stock | 14,000,000 | $0.1 | I | See "Explanation of Responses" |
Warrant | 07/31/2007 | 08/01/2012 | Common Stock | 14,000,000 | $0.125 | I | See "Explanation of Responses" |
Convertible Note | 01/09/2009 | 10/09/2009 | Common Stock | 2,570,000 | $0.1 | I | See "Explanation of Responses" |
Convertible Note | 04/27/2009 | 10/09/2009 | Common Stock | 400,000 | $0.1 | I | See "Explanation of Responses" |
Explanation of Responses: |
1. There is no expiration of conversion right of the Series B Preferred Stock |
Remarks: |
All of the equity derivative securities listed under Table II are owned directly and beneficially by Platinum-Montaur Life Sciences, LLC. Dr. Goldberg is a Managing Director of Platinum-Montaur Life Sciences, LLC and may be deemed to be a beneficial owner of such securities. Dr. Goldberg disclaims beneficial ownership of the equity derivative securities listed under Table II and the common stock issuable upon exercise or conversion of such equity derivative securities, except to the extent of his pecuniary interest in Platinum-Montaur Life Sciences, LLC. This report shall not be deemed an admission that Dr. Goldberg is the beneficial owner of these securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. Each of the Series B Preferred Stock, Warrant and Convertible Notes provide a limitation on the conversion or exercise, such that the number of shares of Common Stock that may be acquired by the holder upon conversion or exercise shall be limited to the extent necessary to ensure that following such conversion or exercise, the total number of shares of Common Stock then beneficially owned does not exceed 4.99% and 9.99% of the total number of issued and outstanding shares of Common Stock. |
/s/ MICHAEL M. GOLDBERG | 08/12/2009 | |
** 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. |