SEC Form 4 · accession 0001094891-17-000036
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
Jan 11, 2017
Accepted (ET)
Jan 12, 2017 · 11:10 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001624326
Table I — non-derivative securities
No Table I lines on this filing.
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 | Jan 11, 2017 | P | 25,000 | A | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 25,000 | 44,500 | 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 | 2,220,532 | 2,220,532 | I |
| WarrantsF3 | $5.00 | holding | — | — | — | Oct 28, 2016 | Jan 29, 2022 | Common Stock | 387,020 | 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 | 2,000 | 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.