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