SEC Form 4 · accession 0001094891-16-000651
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
Nov 23, 2016
Accepted (ET)
Nov 28, 2016 · 3:40 pm EST
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 StockF1 | Nov 23, 2016 | P | 2,200 | $8.9849 | A | 25,600 | D | |
| Common StockF2 | holding | — | — | — | 5,713,879 | I | By HCFP/Capital Partners III LLC | |
| Common StockF3 | holding | — | — | — | 2,520,532 | I | By Pavilion Venture Partners LLC | |
| Common StockF4 | holding | — | — | — | 87,020 | I | By HCFP Inc. | |
| Common StockF5 | holding | — | — | — | 125,000 | I | By HCFP/Capital Partners IIIB LLC | |
| Common StockF6 | 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 | Nov 23, 2016 | P | 300 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 300 | 19,550 | D |
| WarrantsF2 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 5,713,879 | 5,713,879 | I |
| WarrantsF3 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 2,220,532 | 2,220,532 | I |
| WarrantsF4 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 387,020 | 387,020 | I |
| WarrantsF5 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 125,000 | 125,000 | I |
| WarrantsF6 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 20,000 | 2,000 | I |
Explanation of responses
- F1The price reported is a weighted average price. These shares were purchased in multiple transactions at prices ranging from $8.71 to $9.50, inclusive. The reporting person undertakes to provide to the issuer, any security holder of the issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the ranges set forth this footnote.
- F2Dr. 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.
- 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.