FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 02/06/2008 |
3. Issuer Name and Ticker or Trading Symbol
ANESIVA, INC. [ ANSV ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Common Stock | 6,172,840 | I | By Alta Partners VIII, L.P.(1) |
Common Stock | 506,606 | I | By Alta California Partners III, L.P.(2) |
Common Stock | 17,199 | I | By Alta Embarcadero Partners III, LLC(3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
1. The shares are owned by Alta Partners VIII, L.P. ("APVIII"). The general partner of APVIII is Alta Partners Management VIII, LLC ("APMVIII"). The Reporting Person is Managing Director of APMVIII. He disclaims beneficial ownership of the shares held by APVIII, except to the extent of his pecuniary interest therein. |
2. The shares are owned by Alta California Partners III, L.P. ("ACPIII"). The general partner of ACPIII is Alta California Management Partners III, LLC ("ACMPIII"). The Reporting Person is Managing Director of ACMPIII. He disclaims beneficial ownership of the shares held by ACPIII, except to the extent of his pecuniary interest therein. |
3. The shares are owned by Alta Embarcadero Partners III, LLC ("AEPIII"). The Reporting Person is a manager of AEPIII. He disclaims beneficial ownership of the shares held by AEPIII, except to the extent of his pecuniary interest therein. |
Remarks: |
Patrick A. Broderick, as Attorney in Fact for Daniel S. Janney | 02/07/2008 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |