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Filing Details

Accession Number:
0000906344-14-000025
Form Type:
4
Zero Holdings:
No
Publication Time:
2014-04-24 16:05:12
Reporting Period:
2014-04-22
Filing Date:
2014-04-24
Accepted Time:
2014-04-24 16:05:12
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
1270735 A Douglas Roeder C/o Delphi Ventures
3000 Sand Hill Road, Bldg.1, Suite 135
Menlo Park CA 94025
Yes 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 2014-04-22 833,333 $12.00 833,333 No 4 P Indirect See Footnotes
Common Stock Acquisiton 2014-04-22 574,933 $0.00 1,408,266 No 4 C Indirect See Footnotes
Common Stock Acquisiton 2014-04-22 384,594 $0.00 1,792,860 No 4 C Indirect See Footnotes
Common Stock Acquisiton 2014-04-22 424,918 $0.00 2,217,778 No 4 C Indirect See Footnotes
Common Stock Acquisiton 2014-04-22 970,167 $0.00 3,187,945 No 4 C Indirect See Footnotes
Common Stock Acquisiton 2014-04-22 347,965 $0.00 3,535,910 No 4 C Indirect See Footnotes
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Indirect See Footnotes
No 4 C Indirect See Footnotes
No 4 C Indirect See Footnotes
No 4 C Indirect See Footnotes
No 4 C Indirect See Footnotes
No 4 C Indirect See Footnotes
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Series A Preferred Stock Disposition 2014-04-22 574,933 $0.00 574,933 $0.00
Common Stock Series B Preferred Stock Disposition 2014-04-22 384,594 $0.00 384,594 $0.00
Common Stock Series C Preferred Stock Disposition 2014-04-22 424,918 $0.00 424,918 $0.00
Common Stock Series D Preferred Stock Disposition 2014-04-22 970,167 $0.00 970,167 $0.00
Common Stock Series E Preferred Stock Acquisiton 2013-11-01 347,965 $0.00 347,965 $0.00
Common Stock Series E Preferred Stock Disposition 2014-04-22 347,965 $0.00 347,965 $0.00
Series D Preferred Stock Warrant to Purchase Series D Preferred Stock (right to buy) Disposition 2014-04-22 45,094 $15.81 45,094 $0.00
Common Stock Warrant to Purchase Common Stock (right to buy) Acquisiton 2014-04-22 45,094 $0.00 45,094 $15.81
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Indirect
0 No 4 C Indirect
0 No 4 C Indirect
0 No 4 C Indirect
347,965 No 4 A Indirect
0 No 4 C Indirect
0 2012-02-02 2019-02-02 No 4 C Indirect
45,094 2012-02-02 2019-02-02 No 4 C Indirect
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Common Stock 149 Direct
Footnotes
  1. These securities are directly held as follows: 247,525 shares by Delphi Ventures VII, L.P. ("Ventures VII"), 2,475 shares by Delphi BioInvestments VII, L.P. ("BioInvestments VII" and together with Ventures VII, the "Delphi VII Funds"), 577,692 shares by Delphi Ventures VIII, L.P. ("Ventures VIII") and 5,641 shares by Delphi BioInvestments VIII, L.P. ("BioInvestments VIII" and together with Ventures VIII, the "Delphi VIII Funds" and collectively with the Delphi VII Funds, the "Delphi Funds"). Delphi Management Partners VII, L.L.C. ("DMP VII") is the general partner of each of Ventures VII and BioInvestments VII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VII Funds. Delphi Management Partners VIII, L.L.C. ("DMP VIII") is the general partner of each of Ventures VIII and BioInvestments VIII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VIII Funds.
  2. The Reporting Person is a managing member of each DMP VII and DMP VIII and may be deemed to share voting and dispositive power over the securities held by the Delphi Funds.The Reporting Person disclaims beneficial ownership of the securities held by the Delphi Funds, except to the extent of any pecuniary interest therein.
  3. These securities are directly held as follows: 569,241 shares by Ventures VII and 5,692 shares by BioInvestments VII. DMP VII is the general partner of each of Ventures VII and BioInvestments VII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VII Funds. The Reporting Person is a managing member of DMP VII and may be deemed to share voting and dispositive power over the securities held by the Delphi VII Funds. The Reporting Person disclaims beneficial ownership of the securities held by the Delphi VII Funds, except to the extent of any pecuniary interest therein.
  4. These securities are directly held as follows: 114,236 shares by Ventures VII, 1,142 shares by BioInvestments VII, 266,613 shares by Ventures VIII and 2,603 shares by BioInvestments VIII. DMP VII is the general partner of each of Ventures VII and BioInvestments VII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VII Funds. DMP VIII is the general partner of each of Ventures VIII and BioInvestments VIII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VIII Funds. The Reporting Person is a managing member of each DMP VII and DMP VIII and may be deemed to share voting and dispositive power over the securities held by the Delphi Funds. The Reporting Person disclaims beneficial ownership of the securities held by the Delphi Funds, except to the extent of any pecuniary interest therein.
  5. These securities are directly held as follows: 105,298 shares by Ventures VII, 1,052 shares by BioInvestments VII, 315,489 shares by Ventures VIII and 3,079 shares by BioInvestments VIII. DMP VII is the general partner of each of Ventures VII and BioInvestments VII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VII Funds. DMP VIII is the general partner of each of Ventures VIII and BioInvestments VIII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VIII Funds. The Reporting Person is a managing member of each of DMP VII and DMP VIII and may be deemed to share voting and dispositive power over the securities held by the Delphi Funds. The Reporting Person disclaims beneficial ownership of the securities held by the Delphi Funds, except to the extent of any pecuniary interest therein.
  6. These securities are directly held as follows: 270,867 shares by Ventures VII, 2,707 shares by BioInvestments VII, 689,858 shares by Ventures VIII and 6,735 shares by BioInvestments VIII. DMP VII is the general partner of each of Ventures VII and BioInvestments VII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VII Funds. DMP VIII is the general partner of each of Ventures VIII and BioInvestments VIII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VIII Funds. The Reporting Person is a managing member of each of DMP VII and DMP VIII and may be deemed to share voting and dispositive power over the securities held by the Delphi Funds. The Reporting Person disclaims beneficial ownership of the securities held by the Delphi Funds, except to the extent of any pecuniary interest therein.
  7. These securities are directly held as follows: 157,386 shares by Ventures VII, 1,573 shares by BioInvestments VII, 187,179 shares by Ventures VIII and 1,827 shares by BioInvestments VIII. DMP VII is the general partner of each of Ventures VII and BioInvestments VII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VII Funds. DMP VIII is the general partner of each of Ventures VIII and BioInvestments VIII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VIII Funds. The Reporting Person is a managing member of each of DMP VII and DMP VIII and may be deemed to share voting and dispositive power over the securities held by the Delphi Funds. The Reporting Person disclaims beneficial ownership of the securities held by the Delphi Funds, except to the extent of any pecuniary interest therein.
  8. 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.
  9. 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.
  10. 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.
  11. These securities are directly held as follows: 25,754 shares by Ventures VII, 257 shares by BioInvestments VII, 18,899 shares by Ventures VIII and 184 shares by BioInvestments VIII. DMP VII is the general partner of each of Ventures VII and BioInvestments VII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VII Funds. DMP VIII is the general partner of each of Ventures VIII and BioInvestments VIII and may be deemed to have sole voting and dispositive power over the securities held by the Delphi VIII Funds. The Reporting Person is a managing member of each of DMP VII and DMP VIII and may be deemed to share voting and dispositive power over the securities held by the Delphi Funds. The Reporting Person disclaims beneficial ownership of the securities held by the Delphi Funds, except to the extent of any pecuniary interest therein.