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OMB APPROVAL
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------ OMB Number: 3235-0287
FORM 4 Expires: January 31, 2005
------ Estimated average burden
hours per response ....... 0.5
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
[ ] Check this box if no longer subject of Section 16. Form 4 or Form 5
obligations may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
InterWest Partners VI, LP
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(Last) (First) (Middle)
2710 Sand Hill Road; Second Floor
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(Street)
Menlo Park, CA 94025
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
TheraSense, Inc. (THER)
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3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary)
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4. Statement for Month/Date/Year
April 29, 2003
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
[ ] Director [X] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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7. Individual or Joint/Group Filing (Check applicable line)
[ ] Form filed by One Reporting Person
[X] Form filed by More Than one Reporting Person
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Page 1 of 3
Form 4 (continued)
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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| | | | Amount | |
| | | | of | |
| | | Securities | Secur- | | Nature
| | | Acquired (A) | ities | Owner- | of
| | | or Disposed | Bene- | ship | Indirect
| | | of (D) (Instr. | ficially | Form: | Bene-
| | Transaction | 3, 4 and 5) | Owned at | Direct | ficial
| | Code | ---------------- | End | (D) or | Owner-
| Transaction | (Instr. 8) | |(A)| | of Month | Indirect | ship
Title of Security | Date | ----------- | Amount|or |Price | (Instr. | (I) | (Instr.
(Instr. 3) | (mm/dd/yy) | Code | V | |(D)| | 3 and 4) | (Instr.4)| 4)
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Common Stock - - - - - 100,306 I By:
InterWest Partners V, LP (1)
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Common Stock - - - - - 3,237,103 D
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Common Stock - - - - - 101,494 I By:
InterWest Investors VI, LP (1)
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Common Stock - - - - - 1,449,082 I By:
InterWest Partners VII, LP (1)
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Common Stock - - - - - 69,396 I By:
InterWest Investors VII, LP (1)
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Common Stock - - - - - 21,764 I By:
W. Scott Hedrick (1)
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Common Stock - - - - - 11,764 I By:
Harvey B. Cash (1)
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Common Stock - - - - - 20,000 I By:
InterWest Venture Mgmt Co.
PSRP FBO Harvey B. Cash (1)
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Common Stock - - - - - 2,000 I By:
Crites Family Trust (1),(3)
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Common Stock - - - - - 27,647 I By:
The Momsen Living Trust
U/A/D 1-5-95 (1),(2)
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Common Stock - - - - - 1,000 I By:
Robert Momsen Custodian
FBO Paige Momsen under CA uniform
TFR to Minor
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Common Stock - - - - - 1,000 I By:
Robert Momsen Custodian
FBO Nick Momsen under
CA uniform TFR to Minor
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Common Stock 4-29-2003 P 75,000 A $7.04 175,000 I By:
InterWest Venture Mgmt Co.
PSRP FBO Robert R. Momsen (1)
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Common Stock - - - - - 10,000 I By:
Gilbert H. Kliman (1)
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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
4(b)(v).
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 CONTROL
NUMBER.
Page 2 of 3
Form 4 (continued)
Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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| | | |Number | | | | Number |Owner-|
| | | |of | | | | of |ship |
| | | |Deriv- | |Title and | | Deriv- |of |
|Conver-| | |ative | |Amount of | | ative |Deriv-|
|sion | | |Secur- | |Underlying | | Secur- |ative |Nature
|of | | |ities | |Securities | | ities |Secur-|of
|Exer- | | |Acquired |Date |(Instr. 3 |Price | Bene- |ity: |In-
|cise | |Trans- |(A) or |Exercisable and |and 4) |of | ficially|Direct|direct
|Price |Trans- |action |Disposed |Expiration Date |-------------|Deriv- | Owned |(D) or|Bene-
|of |action |Code |of(D) |(Month/Day/Year) | |Amount|ative | at End |In- |ficial
Title of |Deriv- |Date |(Instr.|(Instr.3,|-----------------| |or |Secur- | of |direct|Owner-
Derivative |ative |(Month/ |8) |4 and 5) |Date | Expira-| |Number|ity | Month |(I) |ship
Security |Secur- |Day/ |------ |-------- |Exer- | tion | |of |(Instr.| (Instr. |(Instr|(Instr.
(Instr. 3) |ity |Year) |Code|V |(A) | (D)|cisable | Date |Title |Shares|5) | 4) |4) |4)
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Explanation of Responses:
(1) See attached joint filer information.
(2) The shares are held in the name of The Momsen Living Trust U/A/D 1-5-95 of
which Robert Momsen is the Trustee.
(3) The shares are held in the name of Alan W. Crites and Carol B. Crites,
Trustees of the Crites Family Trust-2000 u/i dated 2/18/00.
*See attached signature pages*
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**Signature of Reporting Person Date
** 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 provided is insufficient, see Instruction 6 for procedures.
Potential persons who are to respond to the collection of information
contained in this form are not required to respond unless the form displays
a currently valid OMB Number.
Page 3 of 3
FORM 4
Joint Filer Information
Name: InterWest Partners VI, L.P. ("Partners VI")
InterWest Investors VI, L.P. ("Investors VI")
InterWest Partners VII, L.P. ("Partners VII")
InterWest Investors VII, L.P. ("Investors VII")
InterWest Management Partners VI, LLC
InterWest Management Partners VII, LLC
Harvey B. Cash
Alan W. Crites
Philip T. Gianos
W. Scott Hedrick
W. Stephen Holmes
Gilbert H. Kliman
Thomas L. Rosch
Arnold L. Oronsky
Robert R. Momsen
Address: 2710 Sand Hill Road
Second Floor
Menlo Park, CA 94025
Designated Filer: InterWest Partners VI, L.P.
Issuer and Ticker Symbol: TheraSense, Inc.-("THER")
Statement for Month/Date/Year: April 29, 2003
The individual Reporting Persons listed above (excluding Harvey B.
Cash, Gilbert H. Kliman and Thomas L. Rosch) are general partners of
InterWest Management Partners V, LP. InterWest Management Partners V,
LP has sole voting and investment control over shares owned by
Interwest Partners V, LP ("Partners V"). The individual Reporting
Persons listed above (excluding Thomas L. Rosch) are managing directors
of InterWest Management Partners VI, LLC. InterWest Management Partners
VI, LLC has sole voting and investment control over shares owned by
Partners VI and Investors VI. Certain of the individual Reporting
Persons listed above (excluding Robert R. Momsen) are also managing
directors of InterWest Management Partners VII, LLC. InterWest
Management Partners VII, LLC has sole voting and investment control
over shares owned by Partners VII and Investors VII. All Reporting
Persons disclaim beneficial ownership of shares of TheraSense, Inc.
stock held by Partners V, Partners VI, Investors VI, Partners VII and
Investors VII, except to the extent of their respective pecuniary
interest therein. The filing of this statement shall not be deemed an
admission that, for purposes of Section 16 of the Securities Exchange
Act of 1934, or otherwise, any of the Reporting Persons are the
beneficial owner of all of the equity securities covered by this
statement.
Each of the Reporting Persons listed above hereby designates Partners VI as its
designated filer of Forms 3, 4 and 5 in accordance with Section 16(a) of the
Securities Exchange Act of 1934 and the rules thereunder.
1 of 3
SIGNATURE PAGES TO FORM 4: TheraSense, Inc.
InterWest Partners VI, L.P.
/s/ W. Stephen Holmes 4/30/03
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By: InterWest Management Partners VI, LLC Date
Its General Partner
by W. Stephen Holmes, Managing Director
InterWest Investors VI, L.P.
/s/ W. Stephen Holmes 4/30/03
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By: InterWest Management Partners VI, LLC Date
Its General Partner
by W. Stephen Holmes, Managing Director
InterWest Partners VII, L.P.
/s/ W. Stephen Holmes 4/30/03
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By: InterWest Management Partners VII, LLC Date
Its General Partner
by W. Stephen Holmes, Managing Director
InterWest Investors VII, L.P.
/s/ W. Stephen Holmes 4/30/03
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By: InterWest Management Partners VII, LLC Date
Its General Partner
by W. Stephen Holmes, Managing Director
InterWest Management Partners VI, LLC
/s/ W. Stephen Holmes 4/30/03
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By: W. Stephen Holmes, Managing Director Date
InterWest Management Partners VII, LLC
/s/ W. Stephen Holmes 4/30/03
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By: W. Stephen Holmes, Managing Director Date
SIGNATURE PAGES TO FORM 4: TheraSense, Inc.
/s/ Harvey B. Cash 4/30/03
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By: Harvey B. Cash Date
/s/ Alan W. Crites 4/30/03
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By: Alan W. Crites Date
/s/ Philip T. Gianos 4/30/03
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By: Philip T. Gianos Date
/s/ W. Scott Hedrick 4/30/03
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By: W. Scott Hedrick Date
/s/ W. Stephen Holmes 4/30/03
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By: W. Stephen Holmes Date
/s/ Gilbert H. Kliman 4/30/03
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By: Gilbert H. Kliman Date
/s/ Thomas L. Rosch 4/30/03
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By: Thomas L. Rosch Date
/s/ Arnold L. Oronsky 4/30/03
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By: Arnold L. Oronsky Date
/s/ Robert R. Momsen 4/30/03
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By: Robert R. Momsen Date