Filing Details

Accession Number:
0001181431-14-016851
Form Type:
4
Zero Holdings:
No
Publication Time:
2014-04-24 14:58:00
Reporting Period:
2014-04-22
Filing Date:
2014-04-24
Accepted Time:
2014-04-24 14:58:00
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1432732 Trivascular Technologies Inc. TRIV Surgical & Medical Instruments & Apparatus (3841) 000000000
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1005561 J Peter Barris 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1219855 James M Barrett 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1235112 J Patrick Kerins 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1237289 D Scott Sandell 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1270521 Kittu Krishna Kolluri 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1277631 Forest Baskett 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1383389 Nea 12 Gp, Llc 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1383390 Nea Partners 12, Limited Partnership 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
1383391 New Enterprise Associates 12, Limited Partnership 1954 Greenspring Drive
Suite 600
Timonium MD 21093
No No Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2014-04-22 583,333 $12.00 583,333 No 4 P Direct
Common Stock Acquisiton 2014-04-22 797,208 $0.00 1,380,541 No 4 C Direct
Common Stock Acquisiton 2014-04-22 383,249 $0.00 1,763,790 No 4 C Direct
Common Stock Acquisiton 2014-04-22 531,758 $0.00 2,295,548 No 4 C Direct
Common Stock Acquisiton 2014-04-22 1,236,487 $0.00 3,532,035 No 4 C Direct
Common Stock Acquisiton 2014-04-22 411,234 $0.00 3,943,269 No 4 C Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Direct
No 4 C Direct
No 4 C Direct
No 4 C Direct
No 4 C Direct
No 4 C Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Series A Preferred Stock Disposition 2014-04-22 797,208 $0.00 797,208 $0.00
Common Stock Series B Preferred Stock Disposition 2014-04-22 383,249 $0.00 383,249 $0.00
Common Stock Series C Preferred Stock Disposition 2014-04-22 531,758 $0.00 531,758 $0.00
Common Stock Series D Preferred Stock Disposition 2014-04-22 1,236,487 $0.00 1,236,487 $0.00
Common Stock Series E Preferred Stock Disposition 2014-04-22 411,234 $0.00 411,234 $0.00
Series D Preferred Stock Warrant to Purchase Series D Preferred Stock (right to buy) Disposition 2014-04-22 55,831 $15.81 55,831 $0.00
Common Stock Warrant to Purchase Common Stock (right to buy) Acquisiton 2014-04-22 55,831 $0.00 55,831 $15.81
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Direct
0 No 4 C Direct
0 No 4 C Direct
0 No 4 C Direct
0 No 4 C Direct
0 2012-02-02 2019-02-02 No 4 C Direct
55,831 2012-02-02 2019-02-02 No 4 C Direct
Footnotes
  1. The shares are directly held by New Enterprise Associates 12, Limited Partnership ("NEA 12") and indirectly held by NEA Partners 12, Limited Partnership ("NEA Partners 12"), the sole general partner of NEA 12, NEA 12 GP, LLC ("NEA 12 GP"), the sole general partner of NEA Partners 12, and the individual managers of NEA 12 GP (NEA Partners 12, NEA 12 GP and the individual managers of NEA 12 GP together, the "NEA 12 Indirect Reporting Persons"). The individual managers of NEA 12 GP are M. James Barrett, Peter J. Barris, Forest Baskett, Ryan D. Drant, Patrick J. Kerins, Krishna "Kittu" Kolluri, and Scott D. Sandell. The NEA 12 Indirect Reporting Persons disclaim beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the NEA 12 shares in which the NEA 12 Indirect Reporting Persons have no pecuniary interest.
  2. Each share of Series A Preferred Stock and each share of Series B Preferred Stock converted into 0.03845959625192770 of a share of Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration. The number of securities reported in Table II is shown on an as converted basis. The shares have no expiration date.
  3. Each share of Series C Preferred Stock converted into 0.03899558573514530 of a share of Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration. The number of securities reported in Table II is shown on an as converted basis. The shares have no expiration date.
  4. Each share of Series D Preferred Stock and each share of Series E Preferred Stock converted into 0.02464875523786050 of a share of Common Stock upon the closing of the Issuer's initial public offering without payment of further consideration. The number of securities reported in Table II is shown on an as converted basis. The shares have no expiration date.