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 LEMAITRE VASCULAR, INC. |
63 SECOND AVENUE |
(Street)
|
2. Date of Event Requiring Statement
(Month/Day/Year) 10/18/2006
|
3. Issuer Name and Ticker or Trading Symbol
LEMAITRE VASCULAR INC
[ LMAT ]
|
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X |
Director |
|
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)
|
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) |
05/30/2003
|
05/30/2013 |
Common Stock |
6,361 |
7.86 |
D |
|
Stock Option (Right to Buy) |
01/27/2005
|
01/27/2015 |
Common Stock |
1,503 |
10.45 |
D |
|
Stock Option (Right to Buy) |
07/20/2005
|
07/20/2015 |
Common Stock |
1,327 |
11.3 |
D |
|
Stock Option (Right to Buy) |
04/26/2006
|
04/26/2013 |
Common Stock |
10,809 |
12.37 |
D |
|
Explanation of Responses: |
Remarks: |
|
/s/ Aaron M. Grossman Attorney-in-Fact |
10/18/2006 |
|
** 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. |
rrd116639_131760.html
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that the person whose
signature appears below hereby constitutes and appoints
Aaron M. Grossman and Christopher Martin, and any one of
them acting singly, the true and lawful attorneys-in-fact
and agents, with full power of substitution and
resubstitution, for the undersigned and in the undersigned's
name, place and stead, in any and all capacities (until
revoked in writing) to sign any and all instruments,
certificates and documents required to be executed on behalf
of the undersigned as an individual or on behalf of the
undersigned's holding company, as the case may be, pursuant
to sections 13 and 16 of the Securities Exchange Act of
1934, as amended (the "Exchange Act"), and any and all
regulations promulgated thereunder, 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 or by the By-laws of the
National Association of Securities Dealers, granting unto
said attorneys-in-fact and agents full power and authority
to do and perform each and every act and thing requisite and
necessary fully to all intents and purposes as the
undersigned might or could do in person thereby ratifying
and confirming all that said attorneys-in-fact and agents,
or their substitute or 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 17 day of October, 2006.
/s/ Lawrence J. Jasinski