0001094891-16-000587.txt : 20160825 0001094891-16-000587.hdr.sgml : 20160825 20160825151008 ACCESSION NUMBER: 0001094891-16-000587 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160823 FILED AS OF DATE: 20160825 DATE AS OF CHANGE: 20160825 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PAVmed Inc. CENTRAL INDEX KEY: 0001624326 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 471214177 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: ONE GRAND CENTRAL PLACE STREET 2: SUITE 4600 CITY: NEW YORK STATE: NY ZIP: 10165 BUSINESS PHONE: 212-949-4319 MAIL ADDRESS: STREET 1: ONE GRAND CENTRAL PLACE STREET 2: SUITE 4600 CITY: NEW YORK STATE: NY ZIP: 10165 FORMER COMPANY: FORMER CONFORMED NAME: PAXmed Inc. DATE OF NAME CHANGE: 20141105 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Pavilion Venture Partners LLC CENTRAL INDEX KEY: 0001665114 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37685 FILM NUMBER: 161851388 BUSINESS ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 BUSINESS PHONE: 2124011951 MAIL ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HCFP/Capital Partners III LLC CENTRAL INDEX KEY: 0001665111 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37685 FILM NUMBER: 161851389 BUSINESS ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 BUSINESS PHONE: 2124011951 MAIL ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Aklog Lishan CENTRAL INDEX KEY: 0001665074 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37685 FILM NUMBER: 161851390 MAIL ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10171 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2016-08-23 0001624326 PAVmed Inc. PAVM 0001665074 Aklog Lishan ONE GRAND CENTRAL PLACE SUITE 4600 NEW YORK NY 10165 1 1 1 0 Chairman and CEO 0001665111 HCFP/Capital Partners III LLC ONE GRAND CENTRAL PLACE SUITE 4600 NEW YORK NY 10165 0 0 1 0 0001665114 Pavilion Venture Partners LLC ONE GRAND CENTRAL PLACE SUITE 4600 NEW YORK NY 10165 0 0 1 0 Common Stock 2016-08-23 4 P 0 200 14.05 A 16600 D Common Stock 2016-08-23 4 P 0 800 14.25 A 17400 D Common Stock 2016-08-24 4 P 0 500 14.225 A 17900 D Common Stock 5713879 I By HCFP/Capital Partners III LLC Common Stock 2520532 I By Pavilion Venture Partners LLC Common Stock 87020 I By HCFP Inc. Common Stock 125000 I By HCFP/Capital Partners IIIB LLC Common Stock 20000 I By HCFP/AG LLC Warrants 5.00 2016-08-23 4 P 0 200 6.301 A 2016-10-28 2022-01-29 Common Stock 200 16600 D Warrants 5.00 2016-08-23 4 P 0 500 7.67 A 2016-10-28 2022-01-29 Common Stock 500 17100 D Warrants 5.00 2016-08-23 4 P 0 200 6.35 A 2016-10-28 2022-01-29 Common Stock 200 17300 D Warrants 5.00 2016-08-24 4 P 0 350 6.7968 A 2016-10-28 2022-01-29 Common Stock 350 17650 D Warrants 5.00 2016-10-28 2022-01-29 Common Stock 5713879 5713879 I By HCFP/Capital Partners III LLC Warrants 5.00 2016-10-28 2022-01-29 Common Stock 12000 2220532 I By Pavilion Venture Parnters LLC Warrants 5.00 2016-10-28 2022-01-29 Common Stock 87020 387020 I By HCFP Inc. Warrants 5.00 2016-10-28 2022-01-29 Common Stock 125000 125000 I By HCFP/Capital Partners IIIB LLC Warrants 5.00 2016-10-28 2022-01-29 Common Stock 20000 20000 I By HCFP/AG LLC Dr. 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. Dr. 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. Dr. 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. Dr. 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. Dr. 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. /s/ Dr. Lishan Aklog 2016-08-25 /s/ Dr. Lishan Aklog, as manager of HCFP/Capital Partners III LLC 2016-08-25 /s/ Dr. Lishan Aklog, as manager of Pavilion Venture Partners LLC 2016-08-25