SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Starling William N JR

(Last) (First) (Middle)
3284 ALPINE ROAD

(Street)
PORTOLA VALLEY CA 94028

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/03/2013
3. Issuer Name and Ticker or Trading Symbol
SafeStitch Medical, Inc. [ SFES.OB ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 611,249 I By W. Starling, Jr., and D. Starling, Trustees of the Starling Family Trust, UDT August 15, 1990
Common Stock 23,066 I By Mark Starling, Trustee of the William N. Starling, Jr. and Dana Gregory Starling 1990 Irrevocable
Common Stock 1,960,610 I By Synecor, L.L.C.(1)
Common Stock 16,825,253 I By Synergy Life Science Partners, L.P.(2)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Employee Stock Option (right to buy) (3) 04/12/2022 Common Stock 172,995 $0.07 D
Explanation of Responses:
1. The Reporting Person is a managing member of Synecor, L.L.C ("Synecor"). The Reporting Person disclaims beneficial ownership of the shares held by Synecor except to the extent of his proportionate pecuniary interest therein.
2. The Reporting Person is a Manager of Synergy Venture Partners, LLC which serves as the sole General Partner of Synergy Life Science Partners, LP ("Synergy"). As such, the Reporting Person shares voting and investment control over the securities owned by Synergy, and may be deemed to own beneficially the securities held by Synergy. The Reporting Person disclaims beneficial ownership of the shares held by Synergy except to the extent of this proportionate pecuniary interest therein.
3. This option vests and the shares become exercisable according to the following schedule: 1/48 per month beginning on April 12, 2012.
Remarks:
/s/ William N. Starling, Jr. 09/03/2013
** 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 5 (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.