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