0001144204-16-103214.txt : 20160517
0001144204-16-103214.hdr.sgml : 20160517
20160517211707
ACCESSION NUMBER: 0001144204-16-103214
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160517
FILED AS OF DATE: 20160517
DATE AS OF CHANGE: 20160517
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JAFFE ROSS A MD
CENTRAL INDEX KEY: 0001181338
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659268
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ATWOOD BRIAN G
CENTRAL INDEX KEY: 0001266567
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659269
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LUBASH BARBARA N
CENTRAL INDEX KEY: 0001279592
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659266
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Versant Side Fund III, L.P.
CENTRAL INDEX KEY: 0001456585
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659262
BUSINESS ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
BUSINESS PHONE: 650-233-2211
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Versant Venture Capital III, L.P.
CENTRAL INDEX KEY: 0001456586
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659261
BUSINESS ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
BUSINESS PHONE: 650-233-2211
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Versant Ventures III, LLC
CENTRAL INDEX KEY: 0001456587
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659263
BUSINESS ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
BUSINESS PHONE: 650-233-2211
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Praeger Robin L.
CENTRAL INDEX KEY: 0001456588
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659264
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LINK WILLIAM J PHD
CENTRAL INDEX KEY: 0001228684
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659267
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: PHASERX, INC.
CENTRAL INDEX KEY: 0001429386
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 204690620
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 410 WEST HARRISON STREET
STREET 2: SUITE 300
CITY: SEATTLE
STATE: WA
ZIP: 98119
BUSINESS PHONE: 206-805-6300
MAIL ADDRESS:
STREET 1: 410 WEST HARRISON STREET
STREET 2: SUITE 300
CITY: SEATTLE
STATE: WA
ZIP: 98119
FORMER COMPANY:
FORMER CONFORMED NAME: PHASERX INC
DATE OF NAME CHANGE: 20080311
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: MILDER DONALD B
CENTRAL INDEX KEY: 0001279660
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659265
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: COLELLA SAMUEL D
CENTRAL INDEX KEY: 0001201580
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659260
MAIL ADDRESS:
STREET 1: ONE SANSOME STREET
STREET 2: SUITE 3630
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94104
3
1
v440183_3.xml
OWNERSHIP DOCUMENT
X0206
3
2016-05-17
0
0001429386
PHASERX, INC.
PZRX
0001266567
ATWOOD BRIAN G
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
1
0
1
0
0001456587
Versant Ventures III, LLC
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001456585
Versant Side Fund III, L.P.
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001456586
Versant Venture Capital III, L.P.
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001201580
COLELLA SAMUEL D
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001181338
JAFFE ROSS A MD
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001228684
LINK WILLIAM J PHD
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001279592
LUBASH BARBARA N
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001279660
MILDER DONALD B
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
0001456588
Praeger Robin L.
C/O VERSANT VENTURES
ONE SANSOME STREET, SUITE 3630
SAN FRANCISCO
CA
94104
0
0
1
0
Common Stock
9071
I
By Versant Side Fund III, L.P.
Common Stock
1535476
I
By Versant Venture Capital III, L.P.
Warrants to Purchase Common Stock
7.96
2012-02-01
Common Stock
295
I
By Versant Side Fund III, L.P.
Warrants to Purchase Common Stock
7.96
2012-02-01
Common Stock
49945
I
By Versant Venture Capital III, L.P.
Reflects a 1-for-10.656096 reverse stock split effected on May 17, 2016.
Common stock held of record, respectively, by each of Versant Side Fund III, L.P. and Versant Venture Capital III, L.P., (the "Versant Venture Funds"). Versant Ventures III, LLC is the general partner of the Versant Venture Funds and has voting and dispositive control over securities held by the Versant Venture Funds. Brian G. Atwood, Samuel D. Colella, Ross Jaffe, M.D., William J. Link, Barbara N. Lubash, Donald B. Milder, Bradley J. Bolzon, Charles M. Warden, Robin L. Praeger and Rebecca R. Robertson are the managing directors of Versant Ventures III, LLC and are deemed to have voting and dispositive power over the shares and may be deemed to beneficially own shares held by the Versant Venture Funds. Brian G. Atwood is a managing member of and owns an interest in Versant Ventures III, LLC.
Accordingly, Brian G. Atwood may be deemed to beneficially own the securities held by the Versant Venture Funds. Each of Brian G. Atwood, Samuel D. Colella, Ross Jaffe, M.D., William J. Link, Barbara N. Lubash, Donald B. Milder, Bradley J. Bolzon, Charles M. Warden, Robin L. Praeger and Rebecca R. Robertson disclaims beneficial ownership of these securities except to the extent of their pecuniary interest therein.
The warrants expire at the earlier to occur of (a) February 1, 2019 or (b) the initial public offering of the Issuer's common stock.
This Form 3 is the first of two filings by Brian G. Atwood. Rebecca R. Robertson, Charles M. Warden and Bradley J. Bolzon (the "Other Filers") are also reporting persons. Since the SEC's filing system will not accept CIK and CCC codes from more than ten joint filers of a report, the Other Filers have filed a separate Form 3 that relates to the same securities reported herein. Thus, in total, there are 13 joint filers: the Other Filers and each person that is a signatory to this Form 3.
/s/ ROBIN L. PRAEGER, as Managing Director of Versant Ventures III, LLC
2016-05-17
/s/ ROBIN L. PRAEGER, as Managing Director of Versant Ventures III, LLC the General Partner of Versant Side Fund III, L.P
2016-05-17
/s/ ROBIN L. PRAEGER, as Managing Director of Versant Ventures III, LLC the General Partner of Versant Venture Capital III, L.P.
2016-05-17
/s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Brian Atwood
2016-05-17
/s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Samuel D. Colella
2016-05-17
/s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Ross Jaffe, M.D
2016-05-17
/s/ ROBIN L. PRAEGER, as Attorney-in-Fact for William J. Link
2016-05-17
/s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Barbara N. Lubash
2016-05-17
/s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Donald B. Milder
2016-05-17
/s/ Robin L. Praeger
2016-05-17