SEC Form 4 · accession 0001094891-16-000587
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
Aug 23, 2016
Accepted (ET)
Aug 25, 2016 · 3:10 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 Stock | Aug 23, 2016 | P | 200 | $14.05 | A | 16,600 | D | |
| Common Stock | Aug 23, 2016 | P | 800 | $14.25 | A | 17,400 | D | |
| Common Stock | Aug 24, 2016 | P | 500 | $14.225 | A | 17,900 | D | |
| Common StockF1 | holding | — | — | — | 5,713,879 | I | By HCFP/Capital Partners III LLC | |
| Common StockF2 | holding | — | — | — | 2,520,532 | I | By Pavilion Venture Partners LLC | |
| Common StockF3 | holding | — | — | — | 87,020 | I | By HCFP Inc. | |
| Common StockF4 | holding | — | — | — | 125,000 | I | By HCFP/Capital Partners IIIB LLC | |
| Common StockF5 | holding | — | — | — | 20,000 | I | By HCFP/AG LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Warrants | $5.00 | Aug 23, 2016 | P | 200 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 200 | 16,600 | D |
| Warrants | $5.00 | Aug 23, 2016 | P | 500 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 500 | 17,100 | D |
| Warrants | $5.00 | Aug 23, 2016 | P | 200 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 200 | 17,300 | D |
| Warrants | $5.00 | Aug 24, 2016 | P | 350 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 350 | 17,650 | D |
| WarrantsF1 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 5,713,879 | 5,713,879 | I |
| WarrantsF2 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 12,000 | 2,220,532 | I |
| WarrantsF3 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 87,020 | 387,020 | I |
| WarrantsF4 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 125,000 | 125,000 | I |
| WarrantsF5 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 20,000 | 20,000 | 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.
- F2Dr. 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.
- F3Dr. 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.
- F4Dr. 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.
- F5Dr. 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.