0001209191-19-028122.txt : 20190507
0001209191-19-028122.hdr.sgml : 20190507
20190507195624
ACCESSION NUMBER: 0001209191-19-028122
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190507
FILED AS OF DATE: 20190507
DATE AS OF CHANGE: 20190507
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SANDELL SCOTT D
CENTRAL INDEX KEY: 0001237289
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38886
FILM NUMBER: 19804809
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Trevi Therapeutics, Inc.
CENTRAL INDEX KEY: 0001563880
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 450834299
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 195 CHURCH STREET
STREET 2: 14TH FLOOR
CITY: NEW HAVEN
STATE: CT
ZIP: 06510
BUSINESS PHONE: 203-304-2499
MAIL ADDRESS:
STREET 1: 195 CHURCH STREET
STREET 2: 14TH FLOOR
CITY: NEW HAVEN
STATE: CT
ZIP: 06510
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2019-05-07
0
0001563880
Trevi Therapeutics, Inc.
TRVI
0001237289
SANDELL SCOTT D
1954 GREENSPRING DRIVE
SUITE 600
TIMONIUM
MD
21093
0
0
1
0
Series C Preferred Stock
Common Stock
1937970
I
See Note 2
Stock Option (Right to Buy)
0.001
2022-05-06
Common Stock
1500000
I
See Note 2
The Series C Preferred Stock and the dividends that have accrued thereon to date are convertible on a 9.5-for-one basis into the number of shares of Common Stock shown in Column 3 without payment of further consideration at the holder's election or automatically upon the closing of the Issuer's initial public offering. The number of shares of Common Stock into which the Series C Preferred Stock and accrued dividends thereon are convertible will increase on a daily basis without payment of further consideration as additional dividends accrue. The shares have no expiration date.
The Reporting Person is a manager of NEA 16 GP, LLC, ("NEA 16 GP") which is the sole general partner of NEA Partners 16, L.P. ("NEA Partners 16"). NEA Partners 16 is the sole general partner of New Enterprise Associates 16, L.P. ("NEA 16"), which is the direct beneficial owner of the securities. The Reporting Person disclaims beneficial ownership within the meaning of Section 16 of the Securities Exchange Act of 1934, as amended, or otherwise of such portion of the securities held by NEA 16 in which the Reporting Person has no pecuniary interest.
Exercisable upon closing of the Issuer's initial public offering.
/s/ Sasha Keough, attorney-in-fact
2019-05-07