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*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/12/2018 |
3. Issuer Name and Ticker or Trading Symbol
PAVmed Inc. [ PAVM ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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 | 466,514 | D | |
Common Stock | 1,414,904 | I | See Footnote(1) |
Common Stock | 732,000 | I | See Footnote(2) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 S Warrants (right to buy) | (3) | 06/30/2032 | Common Stock | 1,199,383 | $0.01 | D | |
Series Z Warrants (right to buy) | (4) | 04/30/2024 | Common Stock | 458,257 | $1.6 | D | |
Series Z Warrants (right to buy) | (4) | 04/30/2024 | Common Stock | 857,452 | $1.6 | I | See Footnote(1) |
Series Z Warrants (right to buy) | (4) | 04/30/2024 | Common Stock | 466,000 | $1.6 | I | See Footnote(2) |
Explanation of Responses: |
1. Securities of PAVMed Inc. (the "Issuer") held directly by The Sirovich Family Charitable Foundation (the "Sirovich Foundation"). Matthew Sirovich is a Director and President of the Sirovich Foundation and may be deemed to beneficially own the securities of the Issuer held by the Sirovich Foundation. |
2. Securities of the Issuer held directly by The Boomer Fund, L.P. ("Boomer"). Mr. Sirovich is the general partner of Boomer and may be deemed to beneficially own the securities of the Issuer held by Boomer. |
3. The Series S Warrants cannot be exercised if following such exercise Mr. Sirovich would beneficially own greater than 4.75% of the outstanding shares of the Issuer's common stock and therefore none of the Series S Warrants are currently exercisable. |
4. The Series Z Warrants were exercisable upon issuance. |
/s/ Matthew Sirovich | 06/25/2018 | |
** 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. |