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*
Himawan Jeff

(Last) (First) (Middle)
C/O HORIZON PHARMA, INC.
1033 SKOKIE BLVD., SUITE 355

(Street)
NORTHBROOK IL 60062

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
HORIZON PHARMA, INC. [ HZNP ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/02/2011
4. If Amendment, Date of Original Filed (Month/Day/Year)
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 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
Common Stock 08/02/2011 C 1,431,467(1) A (1) 1,431,467 I See FN(2)
Common Stock 08/02/2011 C 179,317(1) A (1) 1,610,784 I See FN(2)
Common Stock 08/02/2011 C 362,366(3) A $9 1,973,150 I See FN(2)
Common Stock 08/02/2011 P 330,104 A $9 2,303,254 I See FN(2)
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 A Convertible Preferred Stock (1) 08/02/2011 C 1,431,467 (4) (4) Common Stock 1,431,467 $0.00 0 I See FN(2)
Series B Convertible Preferred Stock (1) 08/02/2011 C 179,317 (4) (4) Common Stock 179,317 $0.00 0 I See FN(2)
Convertible Promissory Notes $9 08/02/2011 C $3,261,306.43 (5) (5) Common Stock 362,366 $0.00 0 I See FN(2)
Warrant to Purchase Series A Preferred Stock $5.201 08/02/2011 C(6) 67,970 (7) 10/31/2015(7) Series A Preferred Stock 67,970 $0.00 0 I See FN(2)
Warrant to Purchase Series A Preferred Stock $5.201 08/02/2011 C(6) 33,985 (7) 07/02/2016(7) Series A Preferred Stock 33,985 $0.00 0 I See FN(2)
Warrant to Purchase Series A Preferred Stock $5.201 08/02/2011 C(6) 42,484 (7) 09/25/2016(7) Series A Preferred Stock 42,484 $0.00 0 I See FN(2)
Warrant to Purchase Common Stock $12.35 08/02/2011 C(6) 28,630 (7) 10/31/2015(7) Common Stock 28,630 $0.00 28,630 I See FN(2)
Warrant to Purchase Common Stock $12.35 08/02/2011 C(6) 14,315 (7) 07/02/2016(7) Common Stock 14,315 $0.00 14,315 I See FN(2)
Warrant to Purchase Common Stock $12.35 08/02/2011 C(6) 17,895 (7) 09/25/2016(7) Common Stock 17,895 $0.00 17,895 I See FN(2)
Explanation of Responses:
1. Automatic conversion, in connection with the Issuer's initial public offering, of preferred stock into shares of common stock. Every 2.374 shares of preferred stock converted into one share of common stock upon the closing of the Issuer's initial public offering.
2. The securities are held directly by Essex Woodlands Health Ventures Fund VII, L.P. (the "Fund"). The Reporting Person is a manager of Essex Woodlands Health Ventures VII, L.L.C., which is the general partner of Essex Woodlands Health Ventures VII, L.P., the general partner of the Fund. The Reporting Person disclaims beneficial ownership of these securities, except to the extent of his pecuniary interest therein.
3. Represents shares acquired upon conversion, in connection with the Issuer's initial public offering, of convertible promissory notes.
4. These securities are preferred stock of the Issuer and did not have an expiration date. Prior to the Issuer's initial public offering of common stock, the securities were convertible at any time at the election of the holder. The securities automatically converted into shares of common stock upon the closing of the issuer's initial public offering of common stock.
5. Principal and accrued interest converted upon the Issuer's initial public offering of common stock, into shares of common stock.
6. Automatic conversion, in connection with the Issuer's initial public offering, of warrants to purchase Series A Preferred Stock into warrants to purchase Common Stock. The warrants converted at a rate of 2.374 shares of Series A Preferred Stock to 1 share of Common Stock.
7. The warrants are immediately exercisable and shall terminate on the earlier of the expiration date referenced herein or the occurence of other specified corporate transactions.
Remarks:
/s/ Jeff Himawan 08/04/2011
** 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).
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