SEC Form 4 · accession 0001094891-16-000465
PAVmed Inc. · PAVM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Lishan Aklog
Officer — Chairman and CEO · Director · 10% Owner
HCFP/Capital Partners III LLC
10% Owner
Pavilion Venture Partners LLC
10% Owner
Period of report
Apr 28, 2016
Accepted (ET)
May 2, 2016 · 9:06 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001624326
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF2,F3 | Apr 28, 2016 | A | 12,000 | — | A | 2,520,532 | I | By Pavilion Venture Partners LLC |
| Common StockF2,F4 | Apr 28, 2016 | A | 87,020 | — | A | 87,020 | I | By HCFP Inc. |
| Common StockF2,F5 | Apr 28, 2016 | A | 125,000 | — | A | 125,000 | I | By HCFP/Capital Partners IIIB LLC |
| Common StockF2,F6 | Apr 28, 2016 | A | 20,000 | — | A | 20,000 | I | By HCFP/AG LLC |
| Common StockF1 | holding | — | — | — | 5,713,879 | I | By HCFP/Capital Partners III LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantsF2,F3 | $5.00 | Apr 28, 2016 | A | 12,000 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 12,000 | 2,220,532 | I |
| WarrantsF2,F4 | $5.00 | Apr 28, 2016 | A | 87,020 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 87,020 | 387,020 | I |
| WarrantsF2,F5 | $5.00 | Apr 28, 2016 | A | 125,000 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 125,000 | 125,000 | I |
| WarrantsF2,F6 | $5.00 | Apr 28, 2016 | A | 20,000 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 20,000 | 20,000 | I |
| Employee Stock Option (Right to Buy)F7 | $5.00 | Apr 28, 2016 | A | 278,726 | A | — | Apr 28, 2026 | Common Stock | 278,726 | 278,726 | D |
| WarrantsF1 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 5,713,879 | 5,713,879 | I |
Explanation of responses
- F1Dr. Aklog is a member and a co-manager of HCFP/Capital Partners III LLC, and shares joint voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his proportionate pecuniary interest therein.
- F2The reporting person purchased units from the issuer, each unit consisting of one share of the issuer's common stock and one warrant, at a price of $5.00 per unit. Each warrant entitles the holder to purchase one share of the issuer's common stock at an exercise price of $5.00 per share, subject to adjustment.
- F3Dr. Aklog is a member and sole manager of Pavilion Venture Partners LLC, and has sole voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his proportionate pecuniary interest therein.
- F4Dr. Aklog is a controlling shareholder of HCFP Inc., and shares joint voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his proportionate pecuniary interest therein.
- F5Dr. Aklog is a member and a co-manager of the entity that acts as sole manager of HCFP/Capital Partners IIIB LLC, and shares joint voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his pecuniary interest therein.
- F6Dr. Aklog is a co-manager of HCFP/AG LLC, and shares joint voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his pecuniary interest therein.
- F7The option vests as to 3/36 of the shares on July 28, 2016 and in 33 equal monthly installments thereafter.