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