SEC Form 4 · accession 0001094891-18-000152
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
Pavilion Venture Partners LLC
10% Owner
Period of report
Jun 12, 2018
Accepted (ET)
Jul 11, 2018 · 5:42 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 StockF1 | Jun 12, 2018 | X | 1,018 | — | A | 2,303 | I | By daughter |
| Common StockF1 | Jun 12, 2018 | X | 980 | — | A | 2,280 | I | By son |
| Common Stock | holding | — | — | — | 588,413 | D | ||
| Common StockF2 | holding | — | — | — | 4,456,570 | I | By Pavilion Venture Partners LLC | |
| Common StockF3 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series Z WarrantsF4 | $1.60 | Apr 20, 2018 | G | 12,450 | D | Apr 5, 2018 | Apr 30, 2024 | Common Stock | 12,450 | 363,313 | D |
| Subscription Rights (Right to Buy) | $1.15 | Jun 12, 2018 | X | 1,018 | D | May 23, 2018 | Jun 12, 2018 | Units (1 share of Common Stock and 1 Series Z Warrant) | 1,018 | 0 | I |
| Series Z WarrantsF1 | $1.60 | Jun 12, 2018 | X | 1,018 | A | Apr 5, 2018 | Apr 30, 2024 | Common Stock | 1,018 | 1,018 | I |
| Subscription Rights (Right to Buy) | $1.15 | Jun 12, 2018 | X | 980 | D | May 23, 2018 | Jun 12, 2018 | Units (1 share of Common Stock and 1 Series Z Warrant) | 980 | 0 | I |
| Series Z WarrantsF1 | $1.60 | Jun 12, 2018 | X | 980 | A | Apr 5, 2018 | Apr 30, 2024 | Common Stock | 980 | 980 | I |
| Series Z WarrantsF5,F2 | $1.60 | Jun 26, 2018 | J | 968,019 | A | Apr 5, 2018 | Apr 30, 2024 | Common Stock | 2,078,285 | 2,078,285 | I |
| Series Z WarrantsF3 | $1.60 | holding | — | — | — | Apr 5, 2018 | Apr 30, 2024 | Common Stock | 10,000 | 10,000 | I |
Explanation of responses
- F1The reporting person purchased units from the issuer in the issuer's equity rights offering, each unit consisting of one share of the issuer's common stock and one Series Z Warrant, at a price of $1.15 per unit.
- F2Dr. Aklog is a member and sole manager of Pavilion Venture Partners LLC, and has sole voting and dispositive power over the securities held by this entity. Dr. Aklog disclaims beneficial ownership of securities held by this entity, except to the extent of his proportionate pecuniary interest therein.
- F3Dr. Aklog is a co-manager of HCFP/AG LLC, and shares joint voting and dispositive power over the securities held by this entity. Dr. Aklog disclaims beneficial ownership of securities held by this entity, except to the extent of his pecuniary interest therein.
- F4Reflects 350,538 Series Z Warrants that previously were held indirectly by Dr. Aklog through HCFP/Capital Partners III LLC, and became held directly by Dr. Aklog on June 26, 2018.
- F5The Series Z Warrants were contributed to such entity by its members for no consideration. The contributed Series Z Warrants include 322,673 Series Z Warrants that were previously held indirectly by Dr. Aklog through HCFP/Capital Partners III LLC and became held directly by Dr. Aklog on June 26, 2016.