SEC Form 5 · accession 0001094891-18-000036
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
Dec 31, 2017
Accepted (ET)
Feb 14, 2018 · 5:34 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 | Dec 22, 2017 | G | 150,000 | $0.00 | D | 622,566 | D | |
| Common Stock | Dec 21, 2017 | G | 1,000 | $0.00 | A | 1,285 | I | By daughter |
| Common Stock | Dec 21, 2017 | G | 1,000 | $0.00 | A | 1,300 | I | By son |
| Common StockF2,F3 | Dec 21, 2017 | J | 5,646,562 | — | D | 0 | I | By HCFP/Capital Partners III LLC |
| Common StockF5,F4 | Dec 21, 2017 | J | 1,936,038 | — | A | 4,456,570 | I | By Pavilion Venture Partners LLC |
| Common StockF6 | holding | — | — | — | 20,000 | I | By HCFP/AG LLC |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Reflects 701,077 shares of common stock that were previously held through HCFP/Capital Partners III LLC, and became directly held on December 21, 2017.
- F2The shares of common stock were distributed pro rata by such entity to its equity holders for no consideration.
- F3Dr. 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.
- F4Dr. 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.
- F5The shares of common stock were contributed to such entity by its members for no consideration.
- 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.