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