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*
SIROVICH MATTHEW

(Last) (First) (Middle)
C/O SCOPIA CAPITAL MANAGEMENT LP
152 WEST 57TH STREET, 33RD FLOOR

(Street)
NEW YORK NY 10018

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/12/2018
3. Issuer Name and Ticker or Trading Symbol
PAVmed Inc. [ PAVM ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 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 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)
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.
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