0001209191-19-042453.txt : 20190717 0001209191-19-042453.hdr.sgml : 20190717 20190717173250 ACCESSION NUMBER: 0001209191-19-042453 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190717 FILED AS OF DATE: 20190717 DATE AS OF CHANGE: 20190717 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: 001-38981 FILM NUMBER: 19959872 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Mirum Pharmaceuticals, Inc. CENTRAL INDEX KEY: 0001759425 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 831281555 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 950 TOWER LANE, SUITE 1050 CITY: FOSTER CITY STATE: CA ZIP: 94404 BUSINESS PHONE: 650-667-4085 MAIL ADDRESS: STREET 1: 950 TOWER LANE, SUITE 1050 CITY: FOSTER CITY STATE: CA ZIP: 94404 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2019-07-17 0 0001759425 Mirum Pharmaceuticals, Inc. MIRM 0001237289 SANDELL SCOTT D 1954 GREENSPRING DRIVE SUITE 600 TIMONIUM MD 21093 0 0 1 0 Series A Preferred Stock Common Stock 3736243 I See Note 3 The shares of Series A Preferred Stock have no expiration date and are convertible at any time at the election of the holder without payment of further consideration. Each share of Series A Preferred Stock will automatically convert into 0.125 shares of Common Stock upon the closing of the Issuer's initial public offering. Share numbers give effect to the reverse split of each share of the Issuer's Common Stock into 0.125 shares of Common Stock effected on July 3, 2019, which will be effective for the Preferred Stock upon its conversion to Common Stock upon the closing of the Issuer's initial public offering. 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 shares. 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 shares held by NEA 16 in which the Reporting Person has no pecuniary interest. /s/ Sasha Keough, attorney-in-fact 2019-07-17