UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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. |
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) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Preferred Shares | (1) | (2) | Ordinary Shares | 495,370 | $ (1) | I | By Frazier Healthcare VII, L.P. (3) |
Series A Preferred Shares | (1) | (2) | Ordinary Shares | 141,166 | $ (1) | I | By Frazier Healthcare VII-A, L.P. (4) |
Series B-1 Preferred Shares | (5) | (2) | Ordinary Shares | 189,141 | $ (5) | I | By Frazier Healthcare VII, L.P. (3) |
Series B-1 Preferred Shares | (5) | (2) | Ordinary Shares | 53,899 | $ (5) | I | By Frazier Healthcare VII-A, L.P. (4) |
Series B-2 Preferred Shares | (6) | (2) | Ordinary Shares | 157,701 | $ (6) | I | By Frazier Healthcare VII, L.P. (3) |
Series B-2 Preferred Shares | (6) | (2) | Ordinary Shares | 44,940 | $ (6) | I | By Frazier Healthcare VII-A, L.P. (4) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Heron Patrick J C/O ITERUM THERAPEUTICS PLC, BLK 2 FL. 3, HARCOURT CENTRE, HARCOURT ST. DUBLIN, L2 2 |
X | X | ||
FHM VII, L.L.C. 601 UNION STREET, SUITE 3200 SEATTLE, WA 98101 |
X | |||
FHM VII, L.P. 601 UNION STREET, SUITE 3200 SEATTLE, WA 98101 |
X | |||
Frazier Healthcare VII, L.P. 601 UNION STREET, SUITE 3200 SEATTLE, WA 98101 |
X | |||
Frazier Healthcare VII-A, L.P. 601 UNION STREET, SUITE 3200 SEATTLE, WA 98101 |
X |
/s/ Patrick J. Heron | 05/24/2018 | |
**Signature of Reporting Person | Date | |
FHM VII, L.L.C., By: /s/ Patrick J. Heron, Manager | 05/24/2018 | |
**Signature of Reporting Person | Date | |
FHM VII, L.P, its general partner, By: FHM VII, L.L.C., its general partner, By: /s/ Patrick J. Heron, Manager | 05/24/2018 | |
**Signature of Reporting Person | Date | |
Frazier Healthcare VII, L.P., By: FHM VII, L.P, its general partner, By: FHM VII, L.L.C., its general partner, By: /s/ Patrick J. Heron, Manager | 05/24/2018 | |
**Signature of Reporting Person | Date | |
Frazier Healthcare VII-A, L.P., By: FHM VII, L.P, its general partner, By: FHM VII, L.L.C., its general partner, By: /s/ Patrick J. Heron, Manager | 05/24/2018 | |
**Signature of Reporting Person | Date |
* | 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) | The Series A Preferred Shares are convertible into Ordinary Shares of the Issuer at the option of the holder. The Series A Preferred Shares will automatically convert into Ordinary Shares of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer. |
(2) | Not applicable. |
(3) | These shares are held directly by Frazier Healthcare VII, L.P. ("FH VII"). The general partner of FH VII is FHM VII, L.P. and the general partner of FHM VII, L.P. is FHM VII, L.L.C., and each may be deemed to have sole voting, investment and dispositive power with respect to the shares held by FH VII. The Reporting Person is one of six members of FHM VII, L.L.C. The Reporting Person, FHM VII, L.P. and FHM VII, L.L.C. each disclaim Section 16 beneficial ownership of the securities held by FH VII, except to the extent of his or its pecuniary interest therein, if any. |
(4) | These shares are held directly by Frazier Healthcare VII-A, L.P. ("FH VIIA"). The general partner of FH VIIA is FHM VII, L.P. and the general partner of FHM VII, L.P. is FHM VII, L.L.C., and each may be deemed to have sole voting, investment and dispositive power with respect to the shares held by FH VIIA. The Reporting Person is one of six members of FHM VII, L.L.C. The Reporting Person, FHM VII, L.P. and FHM VII, L.L.C. each disclaim Section 16 beneficial ownership of the securities held by FH VIIA, except to the extent of his or its pecuniary interest therein, if any. |
(5) | The Series B-1 Preferred Shares are convertible into Ordinary Shares of the Issuer at the option of the holder. The Series B-1 Preferred Shares will automatically convert into Ordinary Shares of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer. |
(6) | The Series B-2 Preferred Shares are convertible into Ordinary Shares of the Issuer at the option of the holder. The Series B-2 Preferred Shares will automatically convert into Ordinary Shares of the Issuer on a 1-to-1 basis upon closing of the initial public offering of the Issuer. |