0001094891-17-000275.txt : 20171127 0001094891-17-000275.hdr.sgml : 20171127 20171127174749 ACCESSION NUMBER: 0001094891-17-000275 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171122 FILED AS OF DATE: 20171127 DATE AS OF CHANGE: 20171127 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Aklog Lishan CENTRAL INDEX KEY: 0001665074 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37685 FILM NUMBER: 171223741 MAIL ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10171 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HCFP/Capital Partners III LLC CENTRAL INDEX KEY: 0001665111 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37685 FILM NUMBER: 171223740 BUSINESS ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 BUSINESS PHONE: 2124011951 MAIL ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Pavilion Venture Partners LLC CENTRAL INDEX KEY: 0001665114 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37685 FILM NUMBER: 171223739 BUSINESS ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 BUSINESS PHONE: 2124011951 MAIL ADDRESS: STREET 1: 420 LEXINGTON AVENUE STREET 2: SUITE 300 CITY: NEW YORK STATE: NY ZIP: 10170 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PAVmed Inc. CENTRAL INDEX KEY: 0001624326 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 471214177 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: ONE GRAND CENTRAL PLACE STREET 2: SUITE 4600 CITY: NEW YORK STATE: NY ZIP: 10165 BUSINESS PHONE: 212-949-4319 MAIL ADDRESS: STREET 1: ONE GRAND CENTRAL PLACE STREET 2: SUITE 4600 CITY: NEW YORK STATE: NY ZIP: 10165 FORMER COMPANY: FORMER CONFORMED NAME: PAXmed Inc. DATE OF NAME CHANGE: 20141105 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2017-11-22 0001624326 PAVmed Inc. PAVM 0001665074 Aklog Lishan ONE GRAND CENTRAL PLACE SUITE 4600 NEW YORK NY 10165 1 1 1 0 Chairman and CEO 0001665111 HCFP/Capital Partners III LLC ONE GRAND CENTRAL PLACE SUITE 4600 NEW YORK NY 10165 0 0 1 0 0001665114 Pavilion Venture Partners LLC ONE GRAND CENTRAL PLACE SUITE 4600 NEW YORK NY 10165 0 0 1 0 Common Stock 2017-11-21 4 L 0 1200 4.30 A 71489 D Common Stock 285 I By daughter Common Stock 300 I By son Common Stock 2017-11-22 4 J 0 67317 0 D 5646562 I By HCFP/Capital Partners III LLC Common Stock 2520532 I By Pavilion Venture Partners LLC Common Stock 20000 I By HCFP/AG LLC Warrants 5.00 2016-10-28 2022-01-29 Common Stock 50400 50400 D Warrants 5.00 2017-11-22 4 J 0 67317 0 D 2016-10-28 2022-01-29 Common Stock 5646562 5646562 I By HCFP/Capital Partners III LLC Warrants 5.00 2016-10-28 2022-01-29 Common Stock 2220532 2220532 I By Pavilion Venture Partners LLC Warrants 5.00 2016-10-28 2022-01-29 Common Stock 20000 20000 I By HCFP/AG LLC The shares were purchased at a weighted average price of approximately $4.30 per share. These shares were purchased in multiple transactions at prices ranging from $4.07 to $4.67, inclusive. The reporting person undertakes to provide to PAVmed Inc., any security holder of PAVmed Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares purchased at each separate price within the ranges set forth this footnote to this Form 4. The securities were contributed to an affiliated entity and then distributed pro rata by such entity to its equity holders. Dr. Aklog is a member and a co-manager of HCFP/Capital Partners III LLC, and shares joint voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his proportionate pecuniary interest therein. Dr. Aklog is a member and sole manager of Pavilion Venture Partners LLC, and has sole voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his proportionate pecuniary interest therein. Dr. Aklog is a co-manager of HCFP/AG LLC, and shares joint voting and dispositive power over the shares held by this entity. Dr. Aklog disclaims beneficial ownership of shares held by this entity, except to the extent of his pecuniary interest therein. The reporting person no longer has a reportable beneficial interest in the following securities, which were included in the reporting person's prior ownership reports: (i) 125,000 shares of common stock and 125,000 warrants distributed by HCFP/Capital Partners IIIB LLC to its members on a pro rata basis (none of which were distributed to the reporting person); and (ii) 87,020 shares of common stock and 387,020 warrants held by HCFP Inc., over which the reporting person ceased to have investment control. /s/ Dr. Lishan Aklog 2017-11-27 /s/ Dr. Lishan Aklog, as manager of HCFP/Capital Partners III LLC 2017-11-27 /s/ Dr. Lishan Aklog, as manager of Pavilion Venture Partners LLC 2017-11-27