0001144204-14-057941.txt : 20140925
0001144204-14-057941.hdr.sgml : 20140925
20140925183548
ACCESSION NUMBER: 0001144204-14-057941
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140923
FILED AS OF DATE: 20140925
DATE AS OF CHANGE: 20140925
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: VIVEVE MEDICAL, INC.
CENTRAL INDEX KEY: 0000879682
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
IRS NUMBER: 043153858
STATE OF INCORPORATION: B0
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 150 COMMERCIAL STREET
CITY: SUNNYVALE
STATE: CA
ZIP: 94086
BUSINESS PHONE: 4085301900
MAIL ADDRESS:
STREET 1: 150 COMMERCIAL STREET
CITY: SUNNYVALE
STATE: CA
ZIP: 94086
FORMER COMPANY:
FORMER CONFORMED NAME: PLC SYSTEMS INC
DATE OF NAME CHANGE: 19930328
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Schwab Andrew J.
CENTRAL INDEX KEY: 0001598549
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-11388
FILM NUMBER: 141121615
MAIL ADDRESS:
STREET 1: C/O 5AM VENTURES, 2200 SAND HILL ROAD
STREET 2: SUITE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM CO-INVESTORS II LP
CENTRAL INDEX KEY: 0001390376
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-11388
FILM NUMBER: 141121616
BUSINESS ADDRESS:
STREET 1: 3000 SAND HILL RD
STREET 2: STE 230
CITY: MENLO PK
STATE: CA
ZIP: 94025
MAIL ADDRESS:
STREET 1: 3000 SAND HILL RD
STREET 2: STE 230
CITY: MENLO PK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Ventures II LP
CENTRAL INDEX KEY: 0001386509
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-11388
FILM NUMBER: 141121617
BUSINESS ADDRESS:
STREET 1: 3000 Sand Hill Rd Bldg 4 Ste 230
CITY: Menlo Park
STATE: CA
ZIP: 94025
MAIL ADDRESS:
STREET 1: 3000 Sand Hill Rd Bldg 4 Ste 230
CITY: Menlo Park
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Partners II, LLC
CENTRAL INDEX KEY: 0001555952
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-11388
FILM NUMBER: 141121618
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650.233.8600
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DIEKMAN JOHN D
CENTRAL INDEX KEY: 0001240357
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-11388
FILM NUMBER: 141121619
MAIL ADDRESS:
STREET 1: C/O 5 AM VENTURES
STREET 2: 3000 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ROCKLAGE SCOTT M
CENTRAL INDEX KEY: 0001219014
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-11388
FILM NUMBER: 141121620
MAIL ADDRESS:
STREET 1: 179 SANDY POND ROAD
CITY: LINCOLN
STATE: MA
ZIP: 01773
4
1
v389921_4.xml
OWNERSHIP DOCUMENT
X0306
4
2014-09-23
0
0000879682
VIVEVE MEDICAL, INC.
PLCSD
0001555952
5AM Partners II, LLC
2200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001386509
5AM Ventures II LP
2200 SAND HILL RD, SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001390376
5AM CO-INVESTORS II LP
2200 SAND HILL RD, SUITE 110
MENLO PK
CA
94025
0
0
1
0
0001598549
Schwab Andrew J.
C/O 5AM VENTURES, 2200 SAND HILL ROAD
SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001219014
ROCKLAGE SCOTT M
C/O 5AM VENTURES, 2200 SAND HILL ROAD
SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001240357
DIEKMAN JOHN D
C/O 5 AM VENTURES, 2200 SAND HILL ROAD
SUITE 110
MENLO PARK
CA
94025
0
0
1
0
Common Stock
2014-09-23
4
P
0
5017677
0.53
A
6660205
I
See Footnote
Common Stock
2014-09-23
4
P
0
197987
0.53
A
262798
I
See Footnote
Shares directly beneficially owned by 5AM Ventures II, L.P.
Shares directly beneficially owned by 5AM Co-Investors II, L.P.
5AM Partners II, LLC is the general partner of 5AM Ventures II, L.P. and 5AM Co-Investors II, L.P. and may be deemed to have sole voting and investment power over the shares beneficially owned by 5AM Ventures II, L.P. and 5AM Co-Investors II, L.P. Dr. John Diekman, Andrew Schwab and Dr. Scott Rocklage, the managing members of 5AM Partners II, LLC, and Mark Colella, an assignee of 5AM Partners II, LLC, may be deemed to have shared voting and investment power over the shares beneficially owned by 5AM Ventures II, L.P. and 5AM Co-Investors II, L.P. Each of 5AM Partners II, LLC, Dr. Diekman, Mr. Schwab, Dr. Rocklage and Mr. Colella disclaim beneficial ownership of such shares except to the extent of its or his pecuniary interest therein.
Includes 933,544 shares issued upon conversion of a convertible promissory note issued by Viveve, Inc. in aggregate principal and interest amount of $494,778.44 at a conversion price of $0.53 per share.
Includes 36,836 shares issued upon conversion of a convertible promissory note issue by Viveve, Inc. in aggregate principal and interest amount of $19,522.93 at a conversion price of $0.53 per share.
/s/ Andrew J.Schwab, Managing Member, 5AM Partners II, LLC
2014-09-25
/s/ Andrew J.Schwab, Managing Member, 5AM Ventures II, L.P.
2014-09-25
/s/ Andrew J.Schwab, Managing Member, 5AM Co-Investors II, L.P.
2014-09-25
/s/ Andrw Schwab
2014-09-25
/s/ Dr. Scott Rocklage
2014-09-25
/s/ Dr. John D. Diekman
2014-09-25