0001144204-16-103215.txt : 20160517 0001144204-16-103215.hdr.sgml : 20160517 20160517211749 ACCESSION NUMBER: 0001144204-16-103215 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160517 FILED AS OF DATE: 20160517 DATE AS OF CHANGE: 20160517 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: ROBERTSON REBECCA B CENTRAL INDEX KEY: 0001201585 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161659272 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: 161659273 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: Bolzon Bradley J PhD CENTRAL INDEX KEY: 0001354345 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161659270 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: Warden Charles M CENTRAL INDEX KEY: 0001354802 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161659271 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 3 1 v440238_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 0001201585 ROBERTSON REBECCA B C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001354802 Warden Charles M C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001354345 Bolzon Bradley J PhD 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 second of two filings by Brian G. Atwood. Versant Side Fund III, L.P., Versant Venture Capital III, L.P., Versant Ventures III, LLC, Samuel D. Colella, Ross Jaffe, M.D., William J. Link, Barbara N. Lubash, Donald B. Milder, and Robin L. Praeger (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 Attorney-in-Fact for Brian Atwood 2016-05-17 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Bradley J. Bolzon 2016-05-17 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Charles M. Warden 2016-05-17 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Rebecca R. Robertson 2016-05-17