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