SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
SYNERGY LIFE SCIENCE PARTNERS L P

(Last) (First) (Middle)
3284 ALPINE ROAD

(Street)
PORTOLA VALLEY CA 94028

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
SafeStitch Medical, Inc. [ SFES.OB ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/03/2013
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Preferred Stock $0.4(1) 09/03/2013 P 866,234.4(1) (1) (2) Common Stock 8,662,344 $4 866,234.4 D(3)
1. Name and Address of Reporting Person*
SYNERGY LIFE SCIENCE PARTNERS L P

(Last) (First) (Middle)
3284 ALPINE ROAD

(Street)
PORTOLA VALLEY CA 94028

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Synergy Venture Partners, LLC

(Last) (First) (Middle)
3284 ALPINE ROAD

(Street)
PORTOLA VALLEY CA 94028

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Jain Mudit K.

(Last) (First) (Middle)
3284 ALPINE ROAD

(Street)
PORTOLA VALLEY CA 94028

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Stack Richard S.

(Last) (First) (Middle)
3284 ALPINE ROAD

(Street)
PORTOLA VALLEY CA 94028

(City) (State) (Zip)
Explanation of Responses:
1. On September 3, 2013, SafeStitch Medical, Inc. (the "Issuer") sold and issued to Synergy Life Science Partners, L.P., in a privately negotiated transaction pursuant to a securities purchase agreement, an aggregate of 866,234.4 shares of the Issuer's Series B convertible preferred stock at a purchase price of $4.00 per share. Upon the filing of an Amendment to the Issuer's Certificate of Incorporation with the State of Delaware, each share of the Issuer's Series B convertible preferred stock will automatically convert into ten (10) shares of the Issuer's common stock.
2. The Series B Preferred Stock has no expiration date.
3. Synergy Venture Partners, LLC ("SVP LLC") serves as the sole General Partner of Synergy Life Science Partners, LP ("Synergy"). As such, SVP LLC possesses sole voting and investment control over the securities owned by Synergy, and may be deemed to have indirect beneficial ownership of the securities held by Synergy. SVP LLC, however, owns no securities of the Issuer directly. Messrs. Stack, Jain and Starling are Managers of SVP LLC and share voting and dispositive power over the shares held by Synergy. Starling is a director of the Issuer and, accordingly, files separate Section 16 reports. Each Reporting Person disclaims beneficial ownership of the shares held by Synergy except to the extent of his or its proportionate pecuniary interest therein.
Remarks:
/s/ William N. Starling, Jr., Synergy Life Science Partners, LP 09/03/2013
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (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).
Note: 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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Exhibit 99

Form 4 Joint Filer Information


Name:   Synergy Venture Partners, LLC

Address:   3284 Alpine Road
           Portola Valley, CA 94028

Designated Filer:   Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:   SafeStitch Medical, Inc. (SFES.OB)

Date of Event Requiring Statement:   09/03/2013

Signature:   /s/ William N. Starling, Jr., Synergy Venture Partners, LLC, as
general partner of Synergy Life Science Partners, L.P.


Name:   Mudit Jain

Address:   3284 Alpine Road
           Portola Valley, CA 94028

Designated Filer:   Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:   SafeStitch Medical, Inc. (SFES.OB)

Date of Event Requiring Statement:   09/03/2013

Signature:   /s/ Mudit Jain, as manager of Synergy Venture Partners, LLC


Name:   Richard Stack

Address:   3284 Alpine Road
           Portola Valley, CA 94028

Designated Filer:   Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:   SafeStitch Medical, Inc. (SFES.OB)

Date of Event Requiring Statement:   09/03/2013

Signature:   /s/ Richard Stack, as manager of Synergy Venture Partners, LLC