0000899243-16-031933.txt : 20161019 0000899243-16-031933.hdr.sgml : 20161019 20161019064751 ACCESSION NUMBER: 0000899243-16-031933 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20161019 FILED AS OF DATE: 20161019 DATE AS OF CHANGE: 20161019 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: iRhythm Technologies, Inc. CENTRAL INDEX KEY: 0001388658 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 208149544 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 650 TOWNSEND STREET STREET 2: SUITE 380 CITY: San Francisco STATE: CA ZIP: 94103 BUSINESS PHONE: 415-632-5700 MAIL ADDRESS: STREET 1: 650 TOWNSEND STREET STREET 2: SUITE 380 CITY: San Francisco STATE: CA ZIP: 94103 FORMER COMPANY: FORMER CONFORMED NAME: IRhythm Technologies, Inc. DATE OF NAME CHANGE: 20110429 FORMER COMPANY: FORMER CONFORMED NAME: IRhythm Technologies Inc DATE OF NAME CHANGE: 20070201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Starling William N JR CENTRAL INDEX KEY: 0001324130 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161941821 MAIL ADDRESS: STREET 1: 2300 BUCKSKIN ROAD CITY: POCATELLO STATE: ID ZIP: 83201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stack Richard S. CENTRAL INDEX KEY: 0001584403 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161941822 MAIL ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jain Mudit K. CENTRAL INDEX KEY: 0001584404 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161941823 MAIL ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Synergy Venture Partners, LLC CENTRAL INDEX KEY: 0001584405 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161941824 BUSINESS ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 BUSINESS PHONE: (650) 854-9171 MAIL ADDRESS: STREET 1: 3284 ALPINE ROAD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SYNERGY LIFE SCIENCE PARTNERS L P CENTRAL INDEX KEY: 0001384771 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161941825 BUSINESS ADDRESS: STREET 1: 3282 ALPINE RD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 BUSINESS PHONE: 714-815-9099 MAIL ADDRESS: STREET 1: 3282 ALPINE RD CITY: PORTOLA VALLEY STATE: CA ZIP: 94028 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2016-10-19 0 0001388658 iRhythm Technologies, Inc. IRTC 0001384771 SYNERGY LIFE SCIENCE PARTNERS L P 1350 BAYSHORE HIGHWAY, SUITE 920 BURLINGAME CA 94010 0 0 1 0 0001584405 Synergy Venture Partners, LLC 1350 BAYSHORE HIGHWAY, SUITE 920 BURLINGAME CA 94010 0 0 1 0 0001584404 Jain Mudit K. 1350 BAYSHORE HIGHWAY, SUITE 920 BURLINGAME CA 94010 0 0 1 0 0001584403 Stack Richard S. 1350 BAYSHORE HIGHWAY, SUITE 920 BURLINGAME CA 94010 0 0 1 0 0001324130 Starling William N JR 1350 BAYSHORE HIGHWAY, SUITE 920 BURLINGAME CA 94010 0 0 1 0 Series A Convertible Preferred Stock Common Stock 1555500 D Series A Convertible Preferred Stock Common Stock 4925751 D Series A Convertible Preferred Stock Common Stock 3111000 D Series B Convertible Preferred Stock Common Stock 398659 D Series C Convertible Preferred Stock Common Stock 225649 D Series C Convertible Preferred Stock Common Stock 477524 D Series D Convertible Preferred Stock Common Stock 1053072 D Series E Convertible Preferred Stock Common Stock 670735 D Series E Convertible Preferred Stock Common Stock 332412 D Series D Preferred Stock Warrant (Right to Buy) 0.001 2019-11-01 Common Stock 291672 D Immediately N/A The number of underlying shares of common stock reported in column 3 does not reflect a 5.882698 for 1 reverse stock split, to be effective upon the closing of the issuer's initial public offering. 1-for-1 Synergy Venture Partners, LLC ("SVP LLC") serves as the sole General Partner of Synergy Life Science Partners, LP ("Synergy"). As such, SVP LLC possesses sole voting and investment control over the securities owned by Synergy, and may be deemed to have indirect beneficial ownership of the securities held by Synergy. SVP LLC, however, owns no securities of the Issuer directly. Messrs. Stack, Jain and Starling are Managers of SVP LLC and share voting and dispositive power over the shares held by Synergy. Each Reporting Person disclaims beneficial ownership of the shares held by Synergy except to the extent of his or its proportionate pecuniary interest therein. Converts into common stock on a 2.00438849 for 1 basis. Converts into common stock on a 2.24685484 for 1 basis. The Date of Event is based upon the date of effectiveness of the Issuer's Registration Statement on Form S-1 filed in connection with the Issuer's initial public offering, estimated to be on or about October 19, 2016. /s/ William N. Starling, Jr., Synergy Life Science Partners, LP 2016-10-19 /s/ William N. Starling, Jr., Synergy Venture Partners, LLC 2016-10-19 /s/ Mudit Jain, Synergy Venture Partners, LLC 2016-10-19 /s/ Richard Stack, Synergy Venture Partners, LLC 2016-10-19 EX-99 2 attachment1.htm EX-99 DOCUMENT

                                                                      Exhibit 99

                         Form 3 Joint Filer Information


Name:                                Synergy Venture Partners, LLC

Address:                             1350 Bayshore Highway, Suite 920
                                     Burlingame, CA 94010

Designated Filer:                    Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:              iRhythm Technologies, Inc. (IRTC)

Date of Event Requiring Statement:   October 19, 2016

Signature:                           /s/ William N. Starling, Jr., Synergy
                                     Venture Partners, LLC, as general partner
                                     of Synergy Life Science Partners, L.P.


Name:                                Mudit Jain

Address:                             1350 Bayshore Highway, Suite 920
                                     Burlingame, CA 94010

Designated Filer:                    Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:              iRhythm Technologies, Inc. (IRTC)

Date of Event Requiring Statement:   October 19, 2016

Signature:                           /s/ Mudit Jain, as manager of Synergy
                                     Venture Partners, LLC


Name:                                Richard Stack

Address:                             1350 Bayshore Highway, Suite 920
                                     Burlingame, CA 94010

Designated Filer:                    Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:              iRhythm Technologies, Inc. (IRTC)

Date of Event Requiring Statement:   October 19, 2016

Signature:                           /s/ Richard Stack, as manager of Synergy
                                     Venture Partners, LLC


Name:                                William N. Starling, Jr

Address:                             1350 Bayshore Highway, Suite 920
                                     Burlingame, CA 94010

Designated Filer:                    Synergy Life Science Partners, L.P.

Issuer & Ticker Symbol:              iRhythm Technologies, Inc. (IRTC)

Date of Event Requiring Statement:   October 19, 2016

Signature:                           /s/ William N. Starling, Jr, as manager of
                                     Synergy Venture Partners, LLC