1. Name and Address of Reporting Person * |
Â
STERTZER SIMON H |
|
2. Date of Event Requiring Statement (Month/Day/Year) 10/24/2016 |
3. Issuer Name and Ticker or Trading Symbol BioCardia, Inc. [BCDA]
|
C/O BIOCARDIA, INC., 125 SHOREWAY ROAD, SUITE B |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director |
_____ 10% Owner |
_____ Officer (give title below) |
_____ Other (specify below) |
|
|
5. If Amendment, Date Original Filed(Month/Day/Year)
|
SAN CARLOS, CA 94070 |
6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
|
|
Table I - Non-Derivative Securities Beneficially Owned |
|
1.Title of Security (Instr. 4) |
2. Amount of Securities Beneficially Owned (Instr. 4) |
3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) |
4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock
|
30,956,710
|
I
|
See footnote
(1)
|
Common Stock
|
1,258,925
|
I
|
See footnote
(2)
|
Common Stock
|
5,386,743
|
I
|
See footnote
(3)
|
Common Stock
|
4,716,171
|
I
|
See footnote
(4)
|
|
1. Title of Derivative Security (Instr. 4) |
2. Date Exercisable and Expiration Date (Month/Day/Year) |
3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) |
4. Conversion or Exercise Price of Derivative Security |
5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Director stock option (right to buy)
|
Â
(5)
|
11/11/2020 |
Common Stock
|
162,941
|
$
0.13
|
D
|
Â
|
Director stock option (right to buy)
|
Â
(5)
|
12/23/2020 |
Common Stock
|
54,307
|
$
0.13
|
D
|
Â
|
Director stock option (right to buy)
|
Â
(6)
|
07/09/2023 |
Common Stock
|
678,996
|
$
0.15
|
D
|
Â
|
* |
If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** |
Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) |
These shares are held by the Stertzer Family Trust, of which the Reporting Person and his spouse are co-trustees. |
(2) |
These shares are held by the Stertzer Gamma Trust, of which the Reporting Person is the grantor. |
(3) |
These shares are held by Stertzer Holdings LLC, and the Reporting Person may be deemed to have beneficial ownership of such shares. |
(4) |
These shares are held by Windrock Enterprises L.L.C., of which the Reporting Person and his spouse are sole members and managers. |
(5) |
The shares subject to the option are fully vested and immediately exercisable. |
(6) |
One-forty-eighth of the shares subject to the option vest on August 1, 2013 and each month thereafter, subject to the Reporting Person continuing as a service provider through each such date. |