0001104659-18-047099.txt : 20180725 0001104659-18-047099.hdr.sgml : 20180725 20180725204939 ACCESSION NUMBER: 0001104659-18-047099 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180725 FILED AS OF DATE: 20180725 DATE AS OF CHANGE: 20180725 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Medical Mutual Holdings, Inc. CENTRAL INDEX KEY: 0001732202 STATE OF INCORPORATION: NC FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38601 FILM NUMBER: 18969779 BUSINESS ADDRESS: STREET 1: 700 SPRING FOREST RD. STREET 2: SUITE 400 CITY: RALEIGH STATE: NC ZIP: 27609 BUSINESS PHONE: 9198787614 MAIL ADDRESS: STREET 1: 700 SPRING FOREST RD. STREET 2: SUITE 400 CITY: RALEIGH STATE: NC ZIP: 27609 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Liquidia Technologies Inc CENTRAL INDEX KEY: 0001330436 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE BUSINESS ADDRESS: STREET 1: 419 DAVIS DRIVE STREET 2: SUITE 100 CITY: DURHAM STATE: NC ZIP: 27713 BUSINESS PHONE: 919-328-4400 MAIL ADDRESS: STREET 1: P.O. BOX 110085 CITY: RESEARCH TRIANGLE PARK STATE: NC ZIP: 27709 3 1 a3.xml 3 X0206 3 2018-07-25 0 0001330436 Liquidia Technologies Inc LQDA 0001732202 Medical Mutual Holdings, Inc. 700 SPRING FOREST ROAD SUITE 400 RALEIGH NC 27609 0 0 1 0 Warrant to purchase Series D Preferred Stock 0.01 2017-01-12 2026-12-31 Series D Preferred Stock 27945 I See Footnote Series D Preferred Stock Common Stock 160445 I See Footnote All shares of Series D Preferred Stock, par value $0.001 per share (the "Series D Preferred Stock"), have no expiration date and will automatically convert into the Issuer's common stock on approximately a 0.0594-for-1 basis immediately prior to the closing of the Issuer's initial public offering. Following the automatic conversion of the Series D Preferred Stock, the Warrant to purchase Series D Preferred Stock will be exercisable into 27,945 shares of the Issuer's common stock at an exercise price of $0.01 per share. These securities are held of record by MMIC Investment Holdings ("MMIC"). Medical Mutual Holdings, Inc. is the sole shareholder of MMIC and has exclusive voting and dispositive power over the securities. Jason Sandner, Chief Financial Officer 2018-07-25