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*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
AVALON PHARMACEUTICALS INC [ AVRX ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 10/04/2005 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 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 | 10/04/2005 | P | 154,190 | A | $10.5 | 154,190 | D(1) | |||
Common Stock | 10/04/2005 | P | 27,210 | A | $10.5 | 181,400 | D(2) | |||
Common Stock | 10/04/2005 | C | 187,500 | A | (3) | 368,900 | D(1) | |||
Common Stock | 10/04/2005 | C | 374,571 | A | (4) | 743,471 | D(1) | |||
Common Stock | 10/04/2005 | C | 69,730 | A | $10.5 | 813,201 | D(1) | |||
Common Stock | 10/04/2005 | C | 66,101 | A | (4) | 879,302 | D(2) | |||
Common Stock | 10/04/2005 | C | 12,305 | A | $10.5 | 891,607 | D(2) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 Redeemable Convertible Preferred Stock | (3) | 10/04/2005 | C | 1,500,000 | (3) | (3) | Common Stock | 187,500 | $0.00 | 0 | D(1) | ||||
Series B Redeemable Convertible Preferred Stock | (4) | 10/04/2005 | C | 1,698,927 | (4) | (4) | Common Stock | 374,571 | $0.00 | 0 | D(1) | ||||
8% Convertible Notes | $10.5 | 10/04/2005 | C | $694,181 | (5) | 01/01/2006 | Common Stock | 69,730(5) | $0.00 | 0 | D(1) | ||||
Series B Redeemable Convertible Preferred Stock | (4) | 10/04/2005 | C | 299,810 | (4) | (4) | Common Stock | 66,101 | $0.00 | 0 | D(2) | ||||
8% Convertible Notes | $10.5 | 10/04/2005 | C | $122,502 | (5) | 01/01/2006 | Common Stock | 12,305(5) | $0.00 | 0 | D(2) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Shares directly held by GIMV N.V. |
2. Shares directly held by Adviesbeheer GIMV Life Sciences N.V. |
3. On October 4, 2005, in connection with the closing of the initial public offering of the issuer, the Series A Redeemable Convertible Preferred Stock converted into common stock on a 1-for-0.125 basis and had no expiration date. |
4. On October 4, 2005, in connection with the closing of the initial public offering of the issuer, the Series B Redeemable Convertible Preferred Stock converted into common stock on a 1-for-0.220475 basis and had no expiration date. |
5. The 8% Convertible Notes have a maturity date of January 1, 2006. The 8% Convertible Notes automatically converted into common stock upon the closing of the issuer?s initial public offering at a conversion rate equal to the principal amount of the note, with accrued and unpaid interest, divided by the public offering price per share of the initial public offering. |
Remarks: |
This report is filed jointly by GIMV N.V. and Adviesbeheer GIMV Life Sciences N.V., as members of a Section 13(d) "group." The reported securities are directly held by GIMV N.V. and Adviesbeheer GIMV Life Sciences N.V. GIMV N.V. exercises voting and investment power over these securities through the members of its investment committee. The reporting persons on this Form 4 disclaim beneficial ownership of the reported securities except to the extent of their pecuniary interests therein. |
/s/ Thomas G. David Attorney-in-Fact | 10/06/2005 | |
** 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. | ||
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 Number. |