0001209191-14-027586.txt : 20140415 0001209191-14-027586.hdr.sgml : 20140415 20140415172122 ACCESSION NUMBER: 0001209191-14-027586 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140415 FILED AS OF DATE: 20140415 DATE AS OF CHANGE: 20140415 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: TriVascular Technologies, Inc. CENTRAL INDEX KEY: 0001432732 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3910 BRICKWAY BOULEVARD CITY: SANTA ROSA STATE: CA ZIP: 95403 BUSINESS PHONE: 707-543-8800 MAIL ADDRESS: STREET 1: 3910 BRICKWAY BOULEVARD CITY: SANTA ROSA STATE: CA ZIP: 95403 FORMER COMPANY: FORMER CONFORMED NAME: TV2 HOLDING Co DATE OF NAME CHANGE: 20091116 FORMER COMPANY: FORMER CONFORMED NAME: TV2 HOLDING CO DATE OF NAME CHANGE: 20080417 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: EVNIN LUKE CENTRAL INDEX KEY: 0001134657 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765824 MAIL ADDRESS: STREET 1: THE JOHN HANCOCK TOWER STREET 2: 200 CLARENDON STREET, 54TH STREET CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KAILIAN VAUGHN M CENTRAL INDEX KEY: 0001180429 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765822 MAIL ADDRESS: STREET 1: P.O. BOX 70 CITY: BODEGA STATE: CA ZIP: 94922 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MPM BioVentures IV QP LP CENTRAL INDEX KEY: 0001358309 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765829 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-425-9200 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MPM BioVentures IV GP LLC CENTRAL INDEX KEY: 0001358311 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765826 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-425-9200 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MPM Asset Management Investors BV4 LLC CENTRAL INDEX KEY: 0001358313 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765827 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-425-9200 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Foley Todd CENTRAL INDEX KEY: 0001473930 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765823 MAIL ADDRESS: STREET 1: THE JOHN HANCOCK TOWER STREET 2: 200 CLARENDON STREET 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MPM BioVentures IV GmbH & Co. Beteiligungs KG CENTRAL INDEX KEY: 0001412336 STATE OF INCORPORATION: 2M FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765828 BUSINESS ADDRESS: STREET 1: THE JOHN HANCOCK TOWER STREET 2: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-425-9200 MAIL ADDRESS: STREET 1: THE JOHN HANCOCK TOWER STREET 2: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MPM BioVentures IV LLC CENTRAL INDEX KEY: 0001358312 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36419 FILM NUMBER: 14765825 BUSINESS ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-425-9200 MAIL ADDRESS: STREET 1: 200 CLARENDON STREET, 54TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2014-04-15 0 0001432732 TriVascular Technologies, Inc. TRIV 0001358309 MPM BioVentures IV QP LP C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 0001412336 MPM BioVentures IV GmbH & Co. Beteiligungs KG C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 0001358313 MPM Asset Management Investors BV4 LLC C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 0001358311 MPM BioVentures IV GP LLC C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 0001358312 MPM BioVentures IV LLC C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 0001134657 EVNIN LUKE C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 0001473930 Foley Todd C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 0001180429 KAILIAN VAUGHN M C/O MPM ASSET MANAGEMENT 200 CLARENDON STREET, 54TH FLOOR BOSTON MA 02116 0 0 1 0 Series A Convertible Preferred Stock Common Stock 798329 I See Footnote Series B Convertible Preferred Stock Common Stock 230756 I See Footnote Series C Convertible Preferred Stock Common Stock 114942 I See Footnote Series D Convertible Preferred Stock Common Stock 379599 I See Footnote Series E Convertible Preferred Stock Common Stock 253066 I See Footnote Warrants to Purchase Series D Preferred Stock (Right to Buy) 0.3896 2012-02-12 2019-02-12 Series D Preferred Stock 1516122 I See Footnote Each share of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred is convertible into 0.0384595 shares of Common Stock without payment of further consideration and will automatically convert into 0.0384595 shares of Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration. The shares have no expiration date. The shares are held as follows: 748,227 by MPM BioVentures IV-QP, L.P. ("BV IV QP"), 28,826 by MPM BioVentures IV GmbH & Co. Beteiligungs KG ("BV IV KG") and 21,276 by MPM Asset Management Investors BV4 LLC ("AM BV4"). MPM BioVentures IV GP LLC and MPM BioVentures IV LLC ("BV LLC") are the direct and indirect general partners of BV IV QP and BV IV KG and BV LLC is the manager of AM BV4. Ansbert Gadicke, Luke Evnin, Vaughn M. Kailian, James Paul Scopa and Todd Foley are the members of BV LLC. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. The shares are held as follows: 216,275 by BV IV QP, 8,332 by BV IV KG and 6,149 by AM BV4. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. The shares are held as follows: 107,729 by BV IV QP, 4,150 by BV IV KG and 3,063 by AM BV4. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. Each share of Series D Preferred Stock and Series E Preferred is convertible into 0.0246486 shares of Common Stock without payment of further consideration and will automatically convert into 0.0246486 shares of Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration. The shares have no expiration date. The shares are held as follows: 355,777 by BV IV QP, 13,706 by BV IV KG and 10,116 by AM BV4. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. The shares are held as follows: 237,185 by BV IV QP, 9,137 by BV IV KG and 6,744 by AM BV4. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. Upon the closing of the IPO, these warrants will automatically convert into warrants to purchase an aggregate of 37,369 shares of common stock at an exercise price of $15.8061 per share. The warrants are held as follows: 1,420,973 by BV IV QP, 54,743 by BV IV KG and 40,406 by AM BV4. Each Reporting Person disclaims beneficial ownership of the securities except to the extent of his or its respective pecuniary interest therein. By Luke Evnin, member of MPM BioVentures IV LLC, the managing member of MPM BioVentures IV GP LLC, the general partner of MPM BioVentures IV-QP, L.P. /s/ Luke Evnin 2014-04-15 By Luke Evnin, member of MPM BioVentures IV LLC, the managing member of MPM BioVentures IV GP LLC, the managing limited partner of MPM BioVentures IV GmbH & Co. /s/ Luke Evnin 2014-04-15 By Luke Evnin, member of MPM BioVentures IV LLC, the manager of MPM Asset Management Investors BV4 LLC /s/ Luke Evnin 2014-04-15 By Luke Evnin, member of MPM BioVentures IV LLC, the managing member of MPM BioVentures IV GP LLC /s/ Luke Evnin 2014-04-15 By Luke Evnin, member of MPM BioVentures IV LLC /s/ Luke Evnin 2014-04-15 /s/ Luke Evnin 2014-04-15 /s/ Todd Foley 2014-04-15 /s/ Vaughn M. Kailian 2014-04-15