FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
PAVmed Inc. [ PAVM ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 06/12/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 588,413 | D | ||||||||
Common Stock | 06/12/2018 | X | 1,018 | A | (1) | 2,303 | I | By daughter | ||
Common Stock | 06/12/2018 | X | 980 | A | (1) | 2,280 | I | By son | ||
Common Stock | 4,456,570 | I | By Pavilion Venture Partners LLC(2) | |||||||
Common Stock | 20,000 | I | By HCFP/AG LLC(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series Z Warrants | $1.6 | 04/20/2018 | G | V | 12,450 | 04/05/2018 | 04/30/2024 | Common Stock | 12,450 | $0 | 363,313(4) | D | |||
Subscription Rights (Right to Buy) | $1.15 | 06/12/2018 | X | 1,018 | 05/23/2018 | 06/12/2018 | Units (1 share of Common Stock and 1 Series Z Warrant) | 1,018 | $0 | 0 | I | By daughter | |||
Series Z Warrants | $1.6 | 06/12/2018 | X | 1,018 | 04/05/2018 | 04/30/2024 | Common Stock | 1,018 | (1) | 1,018 | I | By daughter | |||
Subscription Rights (Right to Buy) | $1.15 | 06/12/2018 | X | 980 | 05/23/2018 | 06/12/2018 | Units (1 share of Common Stock and 1 Series Z Warrant) | 980 | $0 | 0 | I | By son | |||
Series Z Warrants | $1.6 | 06/12/2018 | X | 980 | 04/05/2018 | 04/30/2024 | Common Stock | 980 | (1) | 980 | I | By son | |||
Series Z Warrants | $1.6 | 06/26/2018 | J | 968,019 | 04/05/2018 | 04/30/2024 | Common Stock | 2,078,285 | (5) | 2,078,285 | I | By Pavilion Venture Partners LLC(2) | |||
Series Z Warrants | $1.6 | 04/05/2018 | 04/30/2024 | Common Stock | 10,000 | 10,000 | I | By HCFP/AG LLC(3) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. The 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. |
2. Dr. 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. |
3. Dr. 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. |
4. Reflects 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. |
5. The 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. |
Remarks: |
/s/ Dr. Lishan Aklog | 07/11/2018 | |
/s/ Dr. Lishan Aklog, as manager of Pavilion Venture Partners LLC | 07/11/2018 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |