0001209191-14-013039.txt : 20140221 0001209191-14-013039.hdr.sgml : 20140221 20140221160157 ACCESSION NUMBER: 0001209191-14-013039 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140219 FILED AS OF DATE: 20140221 DATE AS OF CHANGE: 20140221 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: AMEDICA Corp CENTRAL INDEX KEY: 0001269026 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1885 WEST 2100 STREET CITY: SALT LAKE CITY STATE: UT ZIP: 84119 BUSINESS PHONE: 801-839-3516 MAIL ADDRESS: STREET 1: 1885 WEST 2100 STREET CITY: SALT LAKE CITY STATE: UT ZIP: 84119 FORMER COMPANY: FORMER CONFORMED NAME: AMEDICA CORP DATE OF NAME CHANGE: 20031104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kipke Arthur Karl CENTRAL INDEX KEY: 0001599635 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-33624 FILM NUMBER: 14633558 MAIL ADDRESS: STREET 1: C/O AMEDICA CORPORATION STREET 2: 1885 WEST 2100 STREET SOUTH CITY: SALT LAKE CITY STATE: UT ZIP: 84119 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-02-19 0 0001269026 AMEDICA Corp AMDA 0001599635 Kipke Arthur Karl C/O HAMPSHIRE GROUP, LLC, 500 PLAZA ON THE LAKE, SUITE #103 AUSTIN TX 78746 0 0 1 0 Common Stock 2014-02-19 4 C 0 16914 A 16914 I By Hampshire Asset Managements, LLC Common Stock 2014-02-19 4 C 0 115656 A 115656 I By KM Healthcare Holdings Common Stock 2014-02-19 4 C 0 25915 A 25915 I By Hampshire Healthcare Partners Common Stock 2014-02-19 4 C 0 1250000 A 1303347 I By Hampshire Med Tech Partners, LP Series D Preferred Stock 2014-02-19 4 C 0 335100 0.00 D Common Stock 16914 0 I By Hampshire Asset Managements, LLC Series D Preferred Stock 2014-02-19 4 C 0 2290600 0.00 D Common Stock 115656 0 I By KM Healthcare Holdings Series D-1 Preferred Stock 2014-02-19 4 C 0 181000 0.00 D Common Stock 11828 0 I By Hampshire Healthcare Partners Series E Preferred Stock 2014-02-19 4 C 0 319542 0.00 D Common Stock 14087 0 I By Hampshire Healthcare Partners Series F Preferred Stock 2014-02-19 4 C 0 5000000 0.00 D Common Stock 1250000 0 I By Hampshire Med Tech Partners, LP Each share of Series D Convertible Preferred Stock converted into 1.3014 shares of the Issuer's Common Stock pursuant to the terms of the Certificate of Designation for Series D Convertible Preferred Stock of the Issuer and had no expiration date. Each share of Series D-1 Convertible Preferred Stock converted into 1.6834 shares of the Issuer's Common Stock pursuant to the terms of the Certificate of Designation for Series D-1 Convertible Preferred Stock of the Issuer and had no expiration date. Each share of Series E Convertible Preferred Stock converted into 1.1363 shares of the Issuer's Common Stock pursuant to the terms of the Certificate of Designation for Series E Convertible Preferred Stock of the Issuer and had no expiration date. Each share of Series F Convertible Preferred Stock converted into 6.44370 shares of the Issuer's Common Stock pursuant to the terms of the Certificate of Designation for Series F Convertible Preferred Stock of the Issuer and had no expiration date. Reflects a 1-for-25.7746 reverse split of the Issuer's common stock effected on February 11, 2014. Shares held by Hampshire Asset Managements, LLC, of which the Reporting Person is the presdent. The Reporting Person disclaims beneficial ownership except to the extent of any pecuniary interest therein. Shares held by KM Healthcare Holdings LP. The Reporting Person shares voting and dispositive power with the general partner of KM Healthcare Holdings LP. The Reporting Person disclaims beneficial ownership except to the extent of any pecuniary interest therein. Shares held by Hampshire Healthcare Partners LP, of which the Reporting Person is the managing member of the general partner, Hampshire Special Opportunities, LLC. The Reporting Person disclaims beneficial ownership except to the extent of any pecuniary interest therein. Shares held by Hampshire Med Tech Partners, LP, of which the Reporting Person is the managing member of the general partner, Hampshire Med Tech Partners GP, LLC. The Reporting Person disclaims beneficial ownership except to the extent of any pecuniary interest therein. /s/Jonathan Ursprung 2014-02-21