SEC FORM
4
SEC Form 4
FORM 4 |
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 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL |
OMB Number: |
3235-0287 |
Estimated average burden |
hours per response: |
0.5 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
ALIGN TECHNOLOGY INC
[ ALGN ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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Director |
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10% Owner |
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Officer (give title below) |
X |
Other (specify below) |
See Remark Section
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3. Date of Earliest Transaction
(Month/Day/Year) 05/04/2004
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. Individual or Joint/Group Filing (Check Applicable Line)
X |
Form filed by One Reporting Person |
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Form filed by More than One Reporting Person |
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
05/04/2004
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P |
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350 |
A |
$18
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25,350
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I |
See Footnote
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Common Stock |
05/04/2004
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P |
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350 |
A |
$18
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25,350
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I |
See Footnote
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Common Stock |
05/07/2004
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P |
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3,525 |
A |
$18
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28,875
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I |
See Footnote
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Common Stock |
05/07/2004
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P |
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3,525 |
A |
$18
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28,875
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I |
See Footnote
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Common Stock |
05/07/2004
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P |
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10,377 |
A |
$18
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10,377
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I |
See Footnote
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Common Stock |
05/10/2004 |
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P |
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8,625 |
A |
$18
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37,500
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I |
See Footnote
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Common Stock |
05/10/2004 |
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P |
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8,625 |
A |
$18
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37,500
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I |
See Footnote
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Common Stock |
05/10/2004 |
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P |
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58,282 |
A |
$17.9222
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68,659
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I |
See Footnote
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Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivative Security (Instr.
3)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
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5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of Responses: |
Remarks: |
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Theodore W. Baker as Attorney in Fact |
05/11/2004 |
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** 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
4
(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. |
Joint Filer Information
Name: Llura L. Gund
Address: 14 Nassau Street
Princeton, NJ 08542
Designated Filer: Gordon Gund
Issuer & Ticker Symbol: Align Technology, Inc. (ALGN)
Date of Event Requiring Statement: 5/11/04
Signature: /s/ Theodore W. Baker
Theodore W. Baker for Llura L. Gund pursuant to a Power
of Attorney previously filed with the Commission.
Joint Filer Information
Name: Grant Gund
Address: 14 Nassau Street
Princeton, NJ 08542
Designated Filer: Gordon Gund
Issuer & Ticker Symbol: Align Technology, Inc. (ALGN)
Date of Event Requiring Statement: 5/11/04
Signature: /s/ Theodore W. Baker
Theodore W. Baker for Grant Gund pursuant to a Power of
Attorney previously filed with the Commission
Joint Filer Information
Name: G. Zachary Gund
Address: 14 Nassau Street
Princeton, NJ 08542
Designated Filer: Gordon Gund
Issuer & Ticker Symbol: Align Technology, Inc. (ALGN)
Date of Event Requiring Statement: 5/11/04
Signature: /s/ Theodore W. Baker *
Theodore W. Baker for G. Zachary Gund pursuant to a
Power of Attorney previously filed with the Commission.
Joint Filer Information
Name: Richard Watson
Address: 14 Nassau Street
Princeton, NJ 08542
Designated Filer: Gordon Gund
Issuer & Ticker Symbol: Align Technology, Inc. (ALGN)
Date of Event Requiring Statement: 5/11/04
Signature: /s/ Theodore W. Baker
Theodore W. Baker for Richard Watson pursuant to a
Power of Attorney previously filed with the Commission.
Joint Filer Information
Name: Rebecca H. Dent
Address: 14 Nassau Street
Princeton, NJ 08542
Designated Filer: Gordon Gund
Issuer & Ticker Symbol: Align Technology, Inc. (ALGN)
Date of Event Requiring Statement: 5/11/04
Signature: /s/ Theodore W. Baker
Theodore W. Baker for Rebecca H. Dent pursuant to a
Power of Attorney previously filed with the Commission.
Joint Filer Information
Name: George Gund III
Address: 14 Nassau Street
Princeton, NJ 08542
Designated Filer: Gordon Gund
Issuer & Ticker Symbol: Align Technology, Inc. (ALGN)
Date of Event Requiring Statement: 5/11/04
Signature: /s/ Theodore W. Baker *
Theodore W. Baker for George Gund III pursuant to a
Power of Attorney previously filed with the Commission.
Joint Filer Information
Name: Gail Barrows
Address: 14 Nassau Street
Princeton, NJ 08542
Designated Filer: Gordon Gund
Issuer & Ticker Symbol: Align Technology, Inc. (ALGN)
Date of Event Requiring Statement: 5/11/04
Signature: /s/ Theodore W. Baker
Theodore W. Baker for Gail Barrows pursuant to a Power
of Attorney previously filed with the Commission.
(continued...)