0001209191-13-053637.txt : 20131121 0001209191-13-053637.hdr.sgml : 20131121 20131121194332 ACCESSION NUMBER: 0001209191-13-053637 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20131119 FILED AS OF DATE: 20131121 DATE AS OF CHANGE: 20131121 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36189 FILM NUMBER: 131236534 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36189 FILM NUMBER: 131236535 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36189 FILM NUMBER: 131236536 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36189 FILM NUMBER: 131236537 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36189 FILM NUMBER: 131236538 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2013-11-19 1 0001438133 TANDEM DIABETES CARE INC TNDM 0001340660 HLM VENTURE PARTNERS II, L.P. 222 BERKELEY STREET BOSTON MA 02116 0 0 0 1 Previously a 10% Owner 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 222 BERKELEY STREET BOSTON MA 02116 0 0 1 0 0001225960 RAY RUSSELL T 222 BERKELEY STREET BOSTON MA 02116 0 0 1 0 Common Stock 2013-11-19 4 C 0 1454058 0.00 A 1454058 D Series C Preferred Stock 2013-11-19 4 C 0 374805 0.00 D Common Stock 223684 0 D Series D Preferred Stock 2013-11-19 4 C 0 2061616 0.00 D Common Stock 1230374 0 D 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. Following the completion of the Issuer's initial public offering, HLM Venture Partners II, L.P. and its affiliated persons are no longer a 10% Owner. Each share of Preferred Stock automatically converted on a 1-to-0.5968 basis into Common Stock immediately upon the consummation of the Issuer's initial public offering and had no expiration date. The number of shares of Preferred Stock reflects the effect of applicable anti-dilution adjustments that occurred as a result of the issuance of the Series D Preferred Stock. /s/ David B. Berger, Attorney-in-Fact for HLM Venture Partners, II, L.P. 2013-11-21 /s/ David B. Berger, Attorney-in-Fact for HLM Venture Associates II, L.L.C. 2013-11-21 /s/ David B. Berger, Attorney-in-Fact for Edward L. Cahill 2013-11-21 /s/ David B. Berger, Attorney-in-Fact for Peter J. Grua 2013-11-21 /s/ David B. Berger, Attorney-in-Fact for Russell T. Ray 2013-11-21