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
 
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1. Name and Address of Reporting Person*
KNUDSON MARK B

(Last) (First) (Middle)
2800 PATTON ROAD

(Street)
ST. PAUL MN 55113

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/14/2007
3. Issuer Name and Ticker or Trading Symbol
EnteroMedics Inc [ ETRM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chrmn, Pres & CEO
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 99,944 I Revocable Trust
Common Stock 19,286 I Family Limited 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
Stock Option (right to buy) 08/16/2004(1) 08/16/2014 Common Stock 69,451 0.46 D
Stock Option (right to buy) (2) 04/27/2015 Common Stock 47,495 0.46 D
Stock Option (right to buy) 04/20/2007(3) 04/20/2016 Common Stock 40,660 0.46 D
Stock Option (right to buy) 02/06/2008(3) 02/06/2017 Common Stock 252,748 5.19 D
Series A Convertible Preferred Stock (4) (4) Common Stock 7,623 (4) I Revocable Trust
Series B Convertible Preferred Stock (5) (5) Common Stock 10,368 (5) I Revocable Trust
Series C Convertible Preferred Stock (5) (5) Common Stock 6,332 (5) I Revocable Trust
Series B Convertible Preferred Stock (5) (5) Common Stock 5,126 (5) I Spouse Revocable Trust
Series C Convertible Preferred Stock (5) (5) Common Stock 3,166 (5) I Spouse Revocable Trust
Warrants (right to buy) (6) 11/13/2010 Common Stock 2,029 0.4333 I Revocable Trust
Warrants (right to buy) (6) 11/13/2010 Common Stock 1,015 0.4333 I Spouse Revocable Trust
Explanation of Responses:
1. Vests 50% immediately, 25% on the first anniversary of the date of grant and 1/36th per month for 36 months thereafter, beginning the date shown.
2. Currently 100% vested in accordance with achievement of milestone vesting terms.
3. Vests 25% on the first anniversary of the date of grant and 1/36th per month for 36 months thereafter, beginning the date shown.
4. The convertible preferred stock will automatically convert into 11,798 shares of common stock upon completion of the initial public offering.
5. The convertible preferred stock will automatically convert one-to-one into common stock upon completion of the initial public offering.
6. Immediately exercisable.
/s/ Mark B. Knudson 11/13/2007
** 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.
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