Statement of Changes in Beneficial Ownership (4)
February 08 2019 - 3:55PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Atkinson James G.
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2. Issuer Name
and
Ticker or Trading Symbol
VIVEVE MEDICAL, INC.
[
VIVE
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director
_____ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
CBO & President
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(Last)
(First)
(Middle)
345 INVERNESS DR. SOUTH, BUILDING B, SUITE 250
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3. Date of Earliest Transaction
(MM/DD/YYYY)
1/29/2019
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(Street)
ENGLEWOOD, CO 80112
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_
X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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1/29/2019
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A
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42420
(1)
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A
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$0
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53945
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D
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Common Stock
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621237
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I
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By IRA
(2)
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Common Stock
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285599
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I
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By Trust
(3)
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Common Stock
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3825
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I
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By Custodian for Child
(4)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Explanation of Responses:
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(1)
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The reporting person is a participant in the Issuer's Amended and Restated 2013 Stock Option and Incentive Plan (the "Plan") and received a restricted stock award of 42,420 shares of common stock on January 29, 2019 (the "Grant Date"). The restricted stock award shall vest in full upon the FDA approval of the Viveve System for improvement of sexual function or stress urinary incontinence (SUI) in the United States.
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(2)
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Shares directly beneficially owned by an individual retirement account created for the benefit of the reporting person (the "IRA"). The reporting person is the beneficiary of the IRA.
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(3)
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Shares directly beneficially owned by Atkinson Family Revocable Trust Dated 08/26/2013 (the "Trust"). The reporting person a trustee and a co-beneficiary of the Trust.
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(4)
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Shares purchased pursuant to a Rule 10b5-1 trading plan adopted by the reporting person as custodian for a minor child.
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Atkinson James G.
345 INVERNESS DR. SOUTH, BUILDING B
SUITE 250
ENGLEWOOD, CO 80112
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CBO & President
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Signatures
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/s/ James G. Atkinson
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2/8/2019
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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