0000899243-16-032260.txt : 20161025 0000899243-16-032260.hdr.sgml : 20161025 20161025134140 ACCESSION NUMBER: 0000899243-16-032260 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20161025 FILED AS OF DATE: 20161025 DATE AS OF CHANGE: 20161025 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: Stack Richard S. CENTRAL INDEX KEY: 0001584403 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161950024 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161950025 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161950026 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37918 FILM NUMBER: 161950027 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-10-25 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 Common Stock 2016-10-25 4 C 0 2384524 A 2384524 D Series A Convertible Preferred Stock 2016-10-25 4 C 0 264419 0.00 D Common Stock 264419 0 D Series A Convertible Preferred Stock 2016-10-25 4 C 0 837328 0.00 D Common Stock 837328 0 D Series A Convertible Preferred Stock 2016-10-25 4 C 0 528838 0.00 D Common Stock 528838 0 D Series B Convertible Preferred Stock 2016-10-25 4 C 0 67768 0.00 D Common Stock 135833 0 D Series C Convertible Preferred Stock 2016-10-25 4 C 0 38358 0.00 D Common Stock 86184 0 D Series C Convertible Preferred Stock 2016-10-25 4 C 0 81174 0.00 D Common Stock 182387 0 D Series D Convertible Preferred Stock 2016-10-25 4 C 0 179011 0.00 D Common Stock 179011 0 D Series E Convertible Preferred Stock 2016-10-25 4 C 0 114018 0.00 D Common Stock 114018 0 D Series E Convertible Preferred Stock 2016-10-25 4 C 0 56506 0.00 D Common Stock 56506 0 D Series D Preferred Stock Warrant (Right to Buy) 0.001 2016-10-25 4 C 0 49581 0.00 D 2012-11-01 2019-11-01 Common Stock 49581 0 D The Series A Convertible Preferred Stock converted into Common Stock on a 1-for-1 basis and had no expiration date. The Series B Convertible Preferred Stock converted into Common Stock on a 2.00438849-for-1 basis and had no expiration date. The Series C Convertible Preferred Stock converted into Common Stock on a 2.24685484-for-1 basis and had no expiration date. The Series D Convertible Preferred Stock converted into Common Stock on a 1-for-1 basis and had no expiration date. The Series E Convertible Preferred Stock converted into Common Stock on a 1-for-1 basis and had no expiration date. Reflects 5.882698 for 1 reverse stock split which became effective on October 5, 2016. 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. Exhibit List Exhibit 99 /s/ William N. Starling, William N. Starling, Jr., Synergy Life Science Partners, LP 2016-10-25 /s/ William N. Starling, William N. Starling, Jr., Synergy Venture Partners, LLC 2016-10-25 /s/ Mudit Jain, Synergy Venture Partners, LLC 2016-10-25 /s/ Richard Stack, Synergy Venture Partners, LLC 2016-10-25 EX-99 2 attachment1.htm EX-99 DOCUMENT

Exhibit 99


Form 4 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 25, 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 25, 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 25, 2016

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