0001094891-18-000095.txt : 20180409 0001094891-18-000095.hdr.sgml : 20180409 20180409155142 ACCESSION NUMBER: 0001094891-18-000095 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180405 FILED AS OF DATE: 20180409 DATE AS OF CHANGE: 20180409 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: 18745575 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: 18745574 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: 18745573 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 2018-04-05 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 Warrants 5.00 2018-04-05 4 D 0 50450 D 2016-10-28 2022-01-29 Common Stock 50450 0 D Series Z Warrants 3.00 2018-04-05 4 A 0 25225 A 2018-04-05 2024-04-30 Common Stock 25225 25225 D Warrants 5.00 2018-04-05 4 D 0 5646562 D 2016-10-28 2022-01-29 Common Stock 5646562 0 I By HCFP/Capital Partners III LLC Series Z Warrants 3.00 2018-04-05 4 A 0 2823281 A 2018-04-05 2024-04-30 Common Stock 2823281 2823281 I By HCFP/Capital Partners III LLC Warrants 5.00 2018-04-05 4 D 0 2220532 D 2016-10-28 2022-01-29 Common Stock 2220532 0 I By Pavilion Venture Partners LLC Series Z Warrants 3.00 2018-04-05 4 A 0 1110266 A 2018-04-05 2024-04-30 Common Stock 1110266 1110266 I By Pavilion Venture Partners LLC Warrants 5.00 2018-04-05 4 D 0 20000 D 2016-10-28 2022-01-29 Common Stock 20000 0 I By HCFP/AG LLC Series Z Warrants 3.00 2018-04-05 4 A 0 10000 A 2018-04-05 2024-04-30 Common Stock 10000 10000 I By HCFP/AG LLC The reporting person disposed of the Warrants in exchange for Series Z Warrants in an issuer exchange offer. Dr. Aklog is a member and a co-manager of HCFP/Capital Partners III LLC, and shares joint voting and dispositive power over the securities held by this entity. Dr. Aklog disclaims beneficial ownership of securities 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 securities held by this entity. Dr. Aklog disclaims beneficial ownership of securities 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 securities held by this entity. Dr. Aklog disclaims beneficial ownership of securities held by this entity, except to the extent of his pecuniary interest therein. /s/ Dr. Lishan Aklog 2018-04-09 /s/ Dr. Lishan Aklog, as manager of HCFP/Capital Partners III LLC 2018-04-09 /s/ Dr. Lishan Aklog, as manager of Pavilion Venture Partners LLC 2018-04-09