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*
Hansen Albert

(Last) (First) (Middle)
126 EAST 56TH STREET, 24TH FLOOR

(Street)
NEW YORK NY 10022

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/17/2004
3. Issuer Name and Ticker or Trading Symbol
QUESTCOR PHARMACEUTICALS INC [ QSC ]
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
Series B Convertible Preferred Stock 01/15/2003 01/01/2006(4) Common Stock 498,300(1) 0.9412 I By Corporate Opportunities Fund, L.P.
Warrants 01/15/2003 01/15/2007 Common Stock 159,456(2) 1.0824 I By Corporate Opportunities Fund (Institutional), L.P.
Series B Convertible Preferred Stock 01/15/2003 01/01/2006(4) Common Stock 2,689,120(1) 0.9412 I By Corporate Opportunities Fund, L.P.
Warrants 01/15/2003 01/15/2007 Common Stock 860,518(2) 1.0824 I Corporate Opportunitites Fund (Institutional), L.P.
Stock Option (Right to Buy)(5) 05/17/2004 05/17/2004 Common Stock 5,000 0.84 D
Stock Option (Right to Buy)(5) 05/17/2004 06/17/2004(6) Common Stock 12,500 0.84 D
Stock Option (Right to Buy)(5) 05/17/2004 05/17/2004 Common Stock 5,000(3) 0.84 I By Corporate Opportunities Fund, L.P. and Corporate Opportunities Fund (Institutional), L.P.
Stock Option (Right to Buy)(5) 05/17/2004 06/17/2004(6) Common Stock 12,500(3) 0.84 I By Corporate Opportunities Fund, L.P. and Corporate Opportunities Fund(Institutional), L.P.
Explanation of Responses:
1. These shares are owned directly by Corporate Opportunities Fund, L.P. and may be deemed to be benefically owned indirectly by Al Hansen, as a manager of SMM Corporate Management, LLC, the genrral partner of Corporate Opportunities Fund, L.P.. Mr. Hansen disclaims any beneficial owenrship of the reported securities except to the extent of any pecuniary interst he may have therein.
2. These shares are owned directly by Corporate Opportunities Fund (Institutional), L.P. and may be deemed to be benefically owned indirectly by Al Hansen, as a manager of SMM Corporate Management, LLC, the genrral partner of Corporate Opportunities Fund (Institutional), L.P.. Mr. Hansen disclaims any beneficial owenrship of the reported securities except to the extent of any pecuniary interst he may have therein.
3. These shares are owned directly by Corporate Opportunities Fund, L.P. and Corporate Opportunities Fund (Institutional), L.P. and may be deemed to be benefically owned indirectly by Al Hansen, as a manager of SMM Corporate Management, LLC, the genrral partner of Corporate Opportunities Fund, L.P. and Corporate Opportunities Fund (Institutional), L.P.. Mr. Hansen disclaims any beneficial owenrship of the reported securities except to the extent of any pecuniary interst he may have therein.
4. The shares are redeemable by the issuer commencing January 1, 2006. The holder has the right to require the issuer to redeem its shares upon the occurrence of certain events.
5. Options granted under the Questcor Pharmaceuticals, Inc. 2004 Non-Employee Director Equity Incentive Plan
6. Options vest monthly over 48 months from the date of grant.
Albert Hansen 05/27/2004
** 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.