0001144204-16-103217.txt : 20160517
0001144204-16-103217.hdr.sgml : 20160517
20160517211845
ACCESSION NUMBER: 0001144204-16-103217
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: ROCKLAGE SCOTT M
CENTRAL INDEX KEY: 0001219014
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659283
MAIL ADDRESS:
STREET 1: 179 SANDY POND ROAD
CITY: LINCOLN
STATE: MA
ZIP: 01773
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DIEKMAN JOHN D
CENTRAL INDEX KEY: 0001240357
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659282
MAIL ADDRESS:
STREET 1: C/O 5 AM VENTURES
STREET 2: 3000 SAND HILL RD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Ventures II LP
CENTRAL INDEX KEY: 0001386509
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659287
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL RD STE 110
CITY: Menlo Park
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-8600
MAIL ADDRESS:
STREET 1: 2200 SAND HILL RD STE 110
CITY: Menlo Park
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM CO-INVESTORS II LP
CENTRAL INDEX KEY: 0001390376
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659286
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL RD STE 110
CITY: MENLO PK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-233-8600
MAIL ADDRESS:
STREET 1: 2200 SAND HILL RD STE 110
CITY: MENLO PK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: 5AM Partners II, LLC
CENTRAL INDEX KEY: 0001555952
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659285
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL ROAD STE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650.233.8600
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD STE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Schwab Andrew J.
CENTRAL INDEX KEY: 0001598549
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659284
MAIL ADDRESS:
STREET 1: C/O 5AM VENTURES, 2200 SAND HILL ROAD
STREET 2: SUITE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Ulevitch Richard J
CENTRAL INDEX KEY: 0001673244
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37772
FILM NUMBER: 161659288
MAIL ADDRESS:
STREET 1: 200 SAND HILL ROAD
STREET 2: SUITE 110
CITY: MENLO PARK
STATE: CA
ZIP: 94025
3
1
v440251_form3.xml
OWNERSHIP DOCUMENT
X0206
3
2016-05-17
0
0001429386
PHASERX, INC.
PZRX
0001673244
Ulevitch Richard J
C/O 5AM PARTNERS II LLC
200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
1
0
1
0
0001386509
5AM Ventures II LP
200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001390376
5AM CO-INVESTORS II LP
200 SAND HILL ROAD, SUITE 110
MENLO PK
CA
94025
0
0
1
0
0001555952
5AM Partners II, LLC
200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001598549
Schwab Andrew J.
C/O 5AM PARTNERS II LLC
200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001219014
ROCKLAGE SCOTT M
C/O 5AM PARTNERS II LLC
200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
0
0
1
0
0001240357
DIEKMAN JOHN D
C/O 5AM PARTNERS II LLC
200 SAND HILL ROAD, SUITE 110
MENLO PARK
CA
94025
0
0
1
0
Common Stock
1201390
I
By 5AM Ventures II, LP
Common Stock
47406
I
By 5AM Co-Investors II, LP
Warrants to Purchase Common Stock
7.96
2012-02-01
Common Stock
30208
I
By 5AM Ventures II, LP
Warrants to Purchase Common Stock
7.96
2012-02-01
Common Stock
1192
I
By 5AM Co-Investors II, LP
Reflects a 1-for-10.656096 reverse stock split effected on May 17, 2016.
5AM Partners II LLC is the general partner of each of 5AM Ventures II, LP and 5AM Co-Investors II, LP. (the "5AM Ventures") Andrew J. Schwab, John Diekman and Scott M. Rocklage are the managing members of 5AM Partners II LLC and are deemed to have voting and dispositive power over the shares and may be deemed to beneficially own shares held by 5AM Ventures. Dr. Ulevitch is a member of and owns an interest in 5AM Partners II LLC. Accordingly, Mr. Schwab, Dr. Diekman, Mr. Rocklage and Dr. Ulevitch may be deemed to beneficially own the securities held by 5AM Ventures. Mr. Schwab, Dr. Diekman, Mr. Rocklage and Dr. Ulevitch each disclaims beneficial ownership of these securities and this disclosure shall not be deemed an admission that Mr. Schwab, Dr. Diekman, Mr. Rocklage and Dr. Ulevitch is the beneficial owner of such securities for purposes of Section 13(d) of the Securities Exchange Act of 1934, as amended, or any other purpose.
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.
/s/ Andrew J. Schwab, Managing Member of 5AM Partners II LLC
2016-05-17
/s/ Andrew J. Schwab, Managing Member of the general partner of 5AM Ventures II, LP
2016-05-17
/s/ Andrew J. Schwab, Managing Member of the general partner of 5AM Co-Investors II, LP
2016-05-17
/s/ Richard J. Ulevitch
2016-05-17
/s/ Andrew J. Schwab
2016-05-17
/s/ Scott M. Rocklage
2016-05-17
/s/ John Diekman
2016-05-17