0001144204-16-104305.txt : 20160523 0001144204-16-104305.hdr.sgml : 20160523 20160523193012 ACCESSION NUMBER: 0001144204-16-104305 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160523 FILED AS OF DATE: 20160523 DATE AS OF CHANGE: 20160523 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: PHASERX, INC. CENTRAL INDEX KEY: 0001429386 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 204690620 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 410 WEST HARRISON STREET STREET 2: SUITE 300 CITY: SEATTLE STATE: WA ZIP: 98119 BUSINESS PHONE: 206-805-6300 MAIL ADDRESS: STREET 1: 410 WEST HARRISON STREET STREET 2: SUITE 300 CITY: SEATTLE STATE: WA ZIP: 98119 FORMER COMPANY: FORMER CONFORMED NAME: PHASERX INC DATE OF NAME CHANGE: 20080311 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Ulevitch Richard J CENTRAL INDEX KEY: 0001673244 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161670517 MAIL ADDRESS: STREET 1: 200 SAND HILL ROAD STREET 2: SUITE 110 CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 v440736_form4.xml OWNERSHIP DOCUMENT X0306 4 2016-05-23 0 0001429386 PHASERX, INC. PZRX 0001673244 Ulevitch Richard J C/O 5AM PARTNERS II LLC 200 SAND HILL ROAD, SUITE 110 MENLO PARK CA 94025 1 0 0 0 Common Stock 2016-05-23 4 S 0 125829 0.01 D 1117413 I By 5AM Ventures II, LP Common Stock 2016-05-23 4 S 0 312647 0.01 D 804766 I By 5AM Ventures II, LP Common Stock 2016-05-23 4 P 0 96204 5.00 A 900970 I By 5AM Ventures II, LP Common Stock 2016-05-23 4 S 0 4965 0.01 D 44092 I By 5AM Co-Investors II, LP Common Stock 2016-05-23 4 S 0 12336 0.01 D 31756 I By 5AM Co-Investors II, LP Common Stock 2016-05-23 4 P 0 3796 5.00 A 35552 I By 5AM Co-Investors II, LP 5AM Partners II LLC is the general partner of each of 5AM Ventures II, LP and 5AM Co-Investors II, LP ("5AM Ventures"). Andrew J. Schwab, John Diekman and Scott M. Rocklage are the managing members of 5AM Partners II LLC and are deemed to have voting and dispositive power over the shares and may be deemed to beneficially own shares held by 5AM Ventures. Dr. Ulevitch is a member of and owns an interest in 5AM Partners II LLC. Accordingly, Mr. Schwab, Dr. Diekman, Mr. Rocklage and Dr. Ulevitch may be deemed to beneficially own the securities held by 5AM Ventures. Mr. Schwab, Dr. Diekman, Mr. Rocklage and Dr. Ulevitch each disclaims beneficial ownership of these securities and this disclosure shall not be deemed an admission that Mr. Schwab, Dr. Diekman, Mr. Rocklage and Dr. Ulevitch is the beneficial owner of such securities for purposes of Section 13(d) of the Securities Exchange Act of 1934, as amended, or any other purpose. /s/ Richard J. Ulevitch 2016-05-23