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