0001209191-13-052062.txt : 20131113
0001209191-13-052062.hdr.sgml : 20131113
20131113194007
ACCESSION NUMBER: 0001209191-13-052062
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20131113
FILED AS OF DATE: 20131113
DATE AS OF CHANGE: 20131113
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: TANDEM DIABETES CARE INC
CENTRAL INDEX KEY: 0001438133
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 204327508
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 11045 ROSELLE STREET
STREET 2: SUITE 200
CITY: San Diego
STATE: CA
ZIP: 92121
BUSINESS PHONE: 858-366-6900
MAIL ADDRESS:
STREET 1: 11045 ROSELLE STREET
STREET 2: SUITE 200
CITY: San Diego
STATE: CA
ZIP: 92121
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: RAY RUSSELL T
CENTRAL INDEX KEY: 0001225960
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36189
FILM NUMBER: 131216259
MAIL ADDRESS:
STREET 1: 2525 DUPONT DR
CITY: IRVINE
STATE: CA
ZIP: 92612
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GRUA PETER J
CENTRAL INDEX KEY: 0001242813
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36189
FILM NUMBER: 131216260
MAIL ADDRESS:
STREET 1: 28 GARDEN ST
CITY: BOSTON
STATE: MA
ZIP: 02114
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CAHILL EDWARD L
CENTRAL INDEX KEY: 0001025665
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36189
FILM NUMBER: 131216261
MAIL ADDRESS:
STREET 1: 10 NORTH CALVERT ST
STREET 2: SUITE 735
CITY: BALTIMORE
STATE: MD
ZIP: 21202
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HLM Venture Associates II, LLC
CENTRAL INDEX KEY: 0001591541
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36189
FILM NUMBER: 131216262
BUSINESS ADDRESS:
STREET 1: 222 BERKELEY STREET
STREET 2: 21ST FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02116
BUSINESS PHONE: 617-266-0030
MAIL ADDRESS:
STREET 1: 222 BERKELEY STREET
STREET 2: 21ST FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02116
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: HLM VENTURE PARTNERS II, L.P.
CENTRAL INDEX KEY: 0001340660
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36189
FILM NUMBER: 131216263
BUSINESS ADDRESS:
STREET 1: 222 BERKELEY STREET, 20TH FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02116
BUSINESS PHONE: 617-266-0030
MAIL ADDRESS:
STREET 1: 222 BERKELEY STREET, 20TH FLOOR
CITY: BOSTON
STATE: MA
ZIP: 02116
FORMER NAME:
FORMER CONFORMED NAME: HLM VENTURE PARTNERS II L P
DATE OF NAME CHANGE: 20051004
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2013-11-13
0
0001438133
TANDEM DIABETES CARE INC
TNDM
0001340660
HLM VENTURE PARTNERS II, L.P.
222 BERKELEY STREET
BOSTON
MA
02116
0
0
1
0
0001591541
HLM Venture Associates II, LLC
222 BERKELEY STREET
BOSTON
MA
02116
0
0
1
0
0001025665
CAHILL EDWARD L
C/O HLM VENTURE PARTNERS
222 BERKELEY STREET
BOSTON
MA
02116
1
0
1
0
0001242813
GRUA PETER J
C/O HLM VENTURE PARTNERS
222 BERKELEY STREET
BOSTON
MA
02116
0
0
1
0
0001225960
RAY RUSSELL T
C/O HLM VENTURE PARTNERS
222 BERKELEY STREET
BOSTON
MA
02116
0
0
1
0
Series C Preferred Stock
0.00
Common Stock
223684
D
Series D Preferred Stock
0.00
Common Stock
1230374
D
Preferred Stock Warrant
4.40
2021-08-17
Series D Preferred Stock
87662
D
Preferred Stock Warrant
4.40
2022-05-25
Series D Preferred Stock
21915
D
Preferred Stock Warrant
4.40
2022-07-17
Series D Preferred Stock
33014
D
The securities are immediately convertible.
The expiration date is not relevant to the conversion of these securities.
The reported securities are owned by HLM Venture Partners II, L.P. HLM Venture Associates II, L.L.C. (the "General Partner"), and Edward L. Cahill, Peter J. Grua and Russell T. Ray, the managing members of the General Partner, may be deemed to share voting and dispositive power over the reported securities but each disclaims beneficial ownership in the securities held by HLM Venture Partners II, L.P., except to the extent of their pecuniary interest therein.
The warrants are immediately exercisable.
Upon the consummation of the Issuer's initial public offering, these warrants will automatically become exercisable for 52,316 shares of the Issuer's common stock at an exercise price of $4.40 per share.
Upon the consummation of the Issuer's initial public offering, these warrants will automatically become exercisable for 13,078 shares of the Issuer's common stock at an exercise price of $4.40 per share.
Upon the consummation of the Issuer's initial public offering, these warrants will automatically become exercisable for 19,702 shares of the Issuer's common stock at an exercise price of $4.40 per share.
/s/ David B. Berger, Attorney-in-Fact for HLM Venture Partners II, L.P.
2013-11-13
/s/ David B. Berger, Attorney-in-Fact for HLM Venture Associates II, L.L.C.
2013-11-13
/s/ David B. Berger, Attorney-in-Fact for Edward L. Cahill
2013-11-13
/s/ David B. Berger, Attorney-in-Fact for Peter J. Grua
2013-11-13
/s/ David B. Berger, Attorney-in-Fact for Russell T. Ray
2013-11-13
EX-24.3_494225
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
The undersigned hereby constitutes and appoints David B. Berger, John Cajigas,
Leigh Vosseller and Bruce Feuchter, or any of them signing individually, the
undersigned's true and lawful attorney-in-fact to:
(1) execute for and on behalf of the undersigned, in the undersigned's capacity
as the beneficial owner of more than ten percent (10.0%) of any class of any
equity security of Tandem Diabetes Care, Inc. (the "Company"), Forms 3, 4 and 5
in accordance with Section 16(a) of the Securities Exchange Act of 1934, as
amended (the "Exchange Act") and the rules and regulations thereunder;
(2) do and perform any and all acts for and on behalf of the undersigned that
may be necessary or desirable to complete and execute any such Forms 3, 4s and
5s and timely file such form with the SEC and any stock exchange or similar
authority; and
(3) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform each and every act and thing whatsoever requisite,
necessary or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution and revocation,
hereby ratifying and confirming all that each such attorney-in-fact, or each
such attorney-in-fact's substitute or substitutes, shall lawfully do or cause to
be done by virtue of this power of attorney and the rights and powers herein
granted. The undersigned acknowledges that each of the foregoing
attorneys-in-fact, in serving in such capacity at the request of the
undersigned, are not assuming, nor is the Company assuming, any of the
undersigned's responsibilities to comply with Section 16 of the Exchange Act.
The undersigned agrees that each such attorney-in-fact may rely entirely on
information furnished orally or in writing by the undersigned to each such
attorney-in-fact. The undersigned also agrees to indemnify and hold harmless
the Company and each such attorney-in-fact against any losses, claims, damages
or liabilities (or actions in these respects) that arise out of or are based on
any untrue statement or omission of necessary facts in the information provided
by the undersigned to such attorney-in-fact for purposes of executing,
acknowledging, delivering and filing Forms 3, 4s or 5s (including amendments
thereto) and agrees to reimburse the Company and each such attorney-in-fact for
any legal or other expenses reasonably incurred in connection with investigating
or defending against any such loss, claim, damage, liability or action.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4s and 5s with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned have caused this Power of Attorney
to be executed as of this 11th day of November 2013.
HLM VENTURE PARTNERS II, L.P.
By: HLM Venture Associates II, L.L.C.
Its: General Partner
/s/ Vincent J. Fabiani, Authorized Signer
HLM VENTURE ASSOCIATES II, L.L.C.
/s/ Vincent J. Fabiani, Authorized Signer
/s/ Edward L. Cahill, an individual
/s/ Peter J. Grua, an individual
/s/ Russell T. Ray, an individual