0001209191-19-042442.txt : 20190717
0001209191-19-042442.hdr.sgml : 20190717
20190717173005
ACCESSION NUMBER: 0001209191-19-042442
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: BASKETT FOREST
CENTRAL INDEX KEY: 0001277631
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38981
FILM NUMBER: 19959854
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
0001277631
BASKETT FOREST
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