0001144204-14-057943.txt : 20140925
0001144204-14-057943.hdr.sgml : 20140925
20140925183817
ACCESSION NUMBER: 0001144204-14-057943
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140923
FILED AS OF DATE: 20140925
DATE AS OF CHANGE: 20140925
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: VIVEVE MEDICAL, INC.
CENTRAL INDEX KEY: 0000879682
STANDARD INDUSTRIAL CLASSIFICATION: ELECTROMEDICAL & ELECTROTHERAPEUTIC APPARATUS [3845]
IRS NUMBER: 043153858
STATE OF INCORPORATION: B0
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 150 COMMERCIAL STREET
CITY: SUNNYVALE
STATE: CA
ZIP: 94086
BUSINESS PHONE: 4085301900
MAIL ADDRESS:
STREET 1: 150 COMMERCIAL STREET
CITY: SUNNYVALE
STATE: CA
ZIP: 94086
FORMER COMPANY:
FORMER CONFORMED NAME: PLC SYSTEMS INC
DATE OF NAME CHANGE: 19930328
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Colella Mark Samuel
CENTRAL INDEX KEY: 0001618336
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-11388
FILM NUMBER: 141121624
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD, SUITE 11-
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
v390057_form4.xml
OWNERSHIP DOCUMENT
X0306
4
2014-09-23
0
0000879682
VIVEVE MEDICAL, INC.
PLCSD
0001618336
Colella Mark Samuel
2200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
1
0
1
0
Common Stock
2014-09-23
4
J
0
1642528
A
1642528
I
See Footnote
Common Stock
2014-09-23
4
P
0
5017677
0.53
A
6660205
I
See Footnote
Common Stock
2014-09-23
4
J
0
64811
A
64811
I
See Footnote
Common Stock
2014-09-23
4
P
0
197987
0.53
A
262798
I
See Footnote
Received in exchange for 134,685,584 Series A Preferred shares, 69,362,763 Series B Preferred shares and the cancellation of promissory notes and warrants in the aggregate amount of $3,313,198.99 of Viveve Inc. in connection with the merger of Viveve Inc. into PLC Systems Inc. (now Viveve Medical Inc.).
Shares directly beneficially owned by 5AM Ventures II, L.P.
5AM Partners II, LLC is the general partner of 5AM Ventures II, L.P. and 5AM Co-Investors II, L.P. and may be deemed to have sole voting and investment power over the shares beneficially owned by 5AM Ventures II, L.P. and 5AM Co-Investors II, L.P. Dr. John Diekman, Andrew Schwab and Dr. Scott Rocklage, the managing members of 5AM Partners II, LLC, and Mark Colella, an assignee of 5AM Partners II, LLC, may be deemed to have shared voting and investment power over the shares beneficially owned by 5AM Ventures II, L.P. and 5AM Co-Investors II, L.P. Each of 5AM Partners II, LLC, Dr. Diekman, Mr. Schwab, Dr. Rocklage and Mr. Colella disclaim beneficial ownership of such shares except to the extent of its or his pecuniary interest therein.
Includes 933,544 shares issued upon conversion of a convertible promissory note issued by Viveve, Inc. in aggregate principal and interest amount of $494,778.44 at a conversion price of $0.53 per share
Received in exchange for 5,314,393 Series A Preferred shares, 2,736,911 Series B Preferred shares and the cancellation of promissory notes and warrants in the aggregate amount of $130,731.94 of Viveve Inc. in connection with the merger of Viveve Inc. into PLC Systems Inc. (now Viveve Medical Inc.).
Shares directly beneficially owned by 5AM Co-Investors II, L.P.
Includes 36,836 shares issued upon conversion of a convertible promissory note issue by Viveve, Inc. in aggregate principal and interest amount of $19,522.93 at a conversion price of $0.53 per share.
/s/ Mark Colella
2014-09-25