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
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1. Name and Address of Reporting Person*
KANIA EDWIN M JR

(Last) (First) (Middle)
C/O TRANSMEDICS GROUP, INC.
200 MINUTEMAN ROAD

(Street)
ANDOVER MA 01810

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/01/2019
3. Issuer Name and Ticker or Trading Symbol
TransMedics Group, Inc. [ TMDX ]
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 363,320(1) I By OneLiberty Ventures 2000, L.P.(2)
Common Stock 7,511(1) I By OneLiberty Advisors Fund 2000, 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
Series A-1 Convertible Preferred Stock (7) (7) Common Stock 793(8) (7) I By OneLiberty Ventures 2000, L.P.(2)
Series B-1 Convertible Preferred Stock (5) (5) Common Stock 62,475(6) (5) I By OneLiberty Ventures 2000, L.P.(2)
Series C Convertible Preferred Stock (3) (3) Common Stock 319,827(4) (3) I By OneLiberty Ventures 2000, L.P.(2)
Series D Convertible Preferred Stock (3) (3) Common Stock 280,000(4) (3) I By OneLiberty Ventures 2000, L.P.(2)
Series F Convertible Preferred Stock (3) (3) Common Stock 143,156(4) (3) I By OneLiberty Ventures 2000, L.P.(2)
Series A-1 Convertible Preferred Stock (7) (7) Common Stock 37(8) (7) I By OneLiberty Advisors Fund 2000, L.P.(2)
Series B-1 Convertible Preferred Stock (5) (5) Common Stock 3,006(6) (5) I By OneLiberty Advisors Fund 2000, L.P.(2)
Series C Convertible Preferred Stock (3) (3) Common Stock 8,966(4) (3) I By OneLiberty Advisors Fund 2000, L.P.(2)
Series D Convertible Preferred Stock (3) (3) Common Stock 5,714(4) (3) I By OneLiberty Advisors Fund 2000, L.P.(2)
Series D Convertible Preferred Stock (3) (3) Common Stock 57,142(4) (3) I By OneLiberty Ventures, Inc.(2)
Explanation of Responses:
1. As of the date of this Form 3, the Common Stock reported herein is common stock of TransMedics, Inc. Immediately prior to the closing of the Issuer's initial public offering, pursuant to the Agreement and Plan of Merger and Reorganization by and among the Issuer, TransMedics, Inc. and TMDX, Inc., dated April 15, 2019 (the "Merger Agreement"), such common stock of TransMedics, Inc. will be converted into shares of common stock of the Issuer on a 3.5-for-one basis (the "Common Stock Conversion"). The number of shares in Column 2 reflects the Reporting Person's holdings following the Common Stock Conversion.
2. Edwin M. Kania, Jr. is a manager of OneLiberty Partners 2000, LLC, which is the general partner of OneLiberty Ventures 2000, L.P. ("OneLiberty 2000") and OneLiberty Advisors Fund 2000, L.P. ("OneLiberty Advisors 2000" and together with OneLiberty 2000, the "OneLiberty Funds"). Mr. Kania is also the principal of OneLiberty Ventures, Inc., which is the management company for, and provides services in connection with the investment activities of, the OneLiberty Funds. By virtue of the foregoing relationships, Mr. Kania may be deemed to indirectly beneficially own the securities held by the OneLiberty Funds and OneLiberty Ventures, Inc., however he disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein.
3. As of the date of this Form 3, the Preferred Stock reported herein is preferred stock of TransMedics, Inc. Immediately prior to the closing of the Issuer's initial public offering, pursuant to the Merger Agreement, each outstanding share of Series C, Series D and Series F preferred stock of TransMedics, Inc. will be converted into shares of common stock of the Issuer based on (i) the one-for-one ratio on which such shares of preferred stock of TransMedics Inc. are convertible into shares of common stock of TransMedics Inc. according to their terms and (ii) the 3.5-for-one ratio on which shares of common stock of TransMedics, Inc. will be converted into shares of common stock of the Issuer (the "Series C, D and F Preferred Stock Conversion"). The Preferred Stock has no expiration date.
4. The number of shares in Column 3 reflects the Reporting Person's holdings following the Series C, D and F Preferred Stock Conversion.
5. As of the date of this Form 3, the Preferred Stock reported herein is preferred stock of TransMedics, Inc. Immediately prior to the closing of the Issuer's initial public offering, pursuant to the Merger Agreement, each outstanding share of Series B-1 preferred stock of TransMedics, Inc. will be converted into shares of common stock of the Issuer based on (i) the ratio on which such shares of preferred stock of TransMedics Inc. are convertible into shares of common stock of TransMedics Inc. according to their terms, determined by dividing the original issue price of $3.416 per share by a conversion price of $12.365, and (ii) the 3.5-for-one ratio on which shares of common stock of TransMedics, Inc. will be converted into shares of common stock of the Issuer (the "Series B-1 Preferred Stock Conversion"). The Preferred Stock has no expiration date.
6. The number of shares in Column 3 reflects the Reporting Person's holdings following the Series B-1 Preferred Stock Conversion.
7. As of the date of this Form 3, the Preferred Stock reported herein is preferred stock of TransMedics, Inc. Immediately prior to the closing of the Issuer's initial public offering, pursuant to the Merger Agreement, each outstanding share of Series A-1 preferred stock of TransMedics, Inc. will be converted into shares of common stock of the Issuer based on (i) the ratio on which such shares of preferred stock of TransMedics Inc. are convertible into shares of common stock of TransMedics Inc. according to their terms, determined by dividing the original issue price of $2.50 per share by a conversion price of $9.680, and (ii) the 3.5-for-one ratio on which shares of common stock of TransMedics, Inc. will be converted into shares of common stock of the Issuer (the "Series A-1 Preferred Stock Conversion"). The Preferred Stock has no expiration date.
8. The number of shares in Column 3 reflects the Reporting Person's holdings following the Series A-1 Preferred Stock Conversion.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ Stephen Gordon, Attorney-in-fact 05/01/2019
** 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).
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