0001209191-13-043283.txt : 20130905 0001209191-13-043283.hdr.sgml : 20130905 20130905184126 ACCESSION NUMBER: 0001209191-13-043283 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20130903 FILED AS OF DATE: 20130905 DATE AS OF CHANGE: 20130905 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SafeStitch Medical, Inc. CENTRAL INDEX KEY: 0000876378 STANDARD INDUSTRIAL CLASSIFICATION: BLANK CHECKS [6770] IRS NUMBER: 112962080 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4400 BISCAYNE BLVD. STREET 2: SUITE A-100 CITY: MIAMI STATE: FL ZIP: 33137 BUSINESS PHONE: 305-575-4600 MAIL ADDRESS: STREET 1: 4400 BISCAYNE BLVD. STREET 2: SUITE A-100 CITY: MIAMI STATE: FL ZIP: 33137 FORMER COMPANY: FORMER CONFORMED NAME: CELLULAR TECHNICAL SERVICES CO INC DATE OF NAME CHANGE: 19930328 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stack Richard S. CENTRAL INDEX KEY: 0001584403 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19437 FILM NUMBER: 131081444 MAIL ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jain Mudit K. CENTRAL INDEX KEY: 0001584404 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19437 FILM NUMBER: 131081445 MAIL ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Synergy Venture Partners, LLC CENTRAL INDEX KEY: 0001584405 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19437 FILM NUMBER: 131081446 BUSINESS ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 BUSINESS PHONE: (650) 854-9171 MAIL ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SYNERGY LIFE SCIENCE PARTNERS L P CENTRAL INDEX KEY: 0001384771 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-19437 FILM NUMBER: 131081447 BUSINESS ADDRESS: STREET 1: 3282 ALPINE RD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 BUSINESS PHONE: 714-815-9099 MAIL ADDRESS: STREET 1: 3282 ALPINE RD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2013-09-03 0 0000876378 SafeStitch Medical, Inc. SFES.OB 0001384771 SYNERGY LIFE SCIENCE PARTNERS L P 3284 ALPINE ROAD PORTOLA VALLEY CA 94028 0 0 1 0 0001584405 Synergy Venture Partners, LLC 3284 ALPINE ROAD PORTOLA VALLEY CA 94028 0 0 1 0 0001584404 Jain Mudit K. 3284 ALPINE ROAD PORTOLA VALLEY CA 94028 0 0 1 0 0001584403 Stack Richard S. 3284 ALPINE ROAD PORTOLA VALLEY CA 94028 0 0 1 0 Series B Preferred Stock 0.40 2013-09-03 4 P 0 866234.4 4.00 A Common Stock 8662344 866234.4 D On September 3, 2013, SafeStitch Medical, Inc. (the "Issuer") sold and issued to Synergy Life Science Partners, L.P., in a privately negotiated transaction pursuant to a securities purchase agreement, an aggregate of 866,234.4 shares of the Issuer's Series B convertible preferred stock at a purchase price of $4.00 per share. Upon the filing of an Amendment to the Issuer's Certificate of Incorporation with the State of Delaware, each share of the Issuer's Series B convertible preferred stock will automatically convert into ten (10) shares of the Issuer's common stock. The Series B Preferred Stock has no expiration date. Synergy Venture Partners, LLC ("SVP LLC") serves as the sole General Partner of Synergy Life Science Partners, LP ("Synergy"). As such, SVP LLC possesses sole voting and investment control over the securities owned by Synergy, and may be deemed to have indirect beneficial ownership of the securities held by Synergy. SVP LLC, however, owns no securities of the Issuer directly. Messrs. Stack, Jain and Starling are Managers of SVP LLC and share voting and dispositive power over the shares held by Synergy. Starling is a director of the Issuer and, accordingly, files separate Section 16 reports. Each Reporting Person disclaims beneficial ownership of the shares held by Synergy except to the extent of his or its proportionate pecuniary interest therein. /s/ William N. Starling, Jr., Synergy Life Science Partners, LP 2013-09-03 EX-99 2 attachment1.txt EX-99 DOCUMENT


Exhibit 99

Form 4 Joint Filer Information


Name:   Synergy Venture Partners, LLC

Address:   3284 Alpine Road
           Portola Valley, CA 94028

Designated Filer:   Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:   SafeStitch Medical, Inc. (SFES.OB)

Date of Event Requiring Statement:   09/03/2013

Signature:   /s/ William N. Starling, Jr., Synergy Venture Partners, LLC, as
general partner of Synergy Life Science Partners, L.P.


Name:   Mudit Jain

Address:   3284 Alpine Road
           Portola Valley, CA 94028

Designated Filer:   Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:   SafeStitch Medical, Inc. (SFES.OB)

Date of Event Requiring Statement:   09/03/2013

Signature:   /s/ Mudit Jain, as manager of Synergy Venture Partners, LLC


Name:   Richard Stack

Address:   3284 Alpine Road
           Portola Valley, CA 94028

Designated Filer:   Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:   SafeStitch Medical, Inc. (SFES.OB)

Date of Event Requiring Statement:   09/03/2013

Signature:   /s/ Richard Stack, as manager of Synergy Venture Partners, LLC