0001144204-16-104556.txt : 20160524 0001144204-16-104556.hdr.sgml : 20160524 20160524170539 ACCESSION NUMBER: 0001144204-16-104556 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160523 FILED AS OF DATE: 20160524 DATE AS OF CHANGE: 20160524 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Praeger Robin L. CENTRAL INDEX KEY: 0001456588 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672539 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MILDER DONALD B CENTRAL INDEX KEY: 0001279660 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672540 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LINK WILLIAM J PHD CENTRAL INDEX KEY: 0001228684 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672542 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Versant Venture Capital III, L.P. CENTRAL INDEX KEY: 0001456586 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672545 BUSINESS ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 BUSINESS PHONE: 650-233-2211 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Versant Side Fund III, L.P. CENTRAL INDEX KEY: 0001456585 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672546 BUSINESS ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 BUSINESS PHONE: 650-233-2211 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Versant Ventures III, LLC CENTRAL INDEX KEY: 0001456587 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672547 BUSINESS ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 BUSINESS PHONE: 650-233-2211 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ATWOOD BRIAN G CENTRAL INDEX KEY: 0001266567 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672548 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: COLELLA SAMUEL D CENTRAL INDEX KEY: 0001201580 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672544 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 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: JAFFE ROSS A MD CENTRAL INDEX KEY: 0001181338 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672543 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: LUBASH BARBARA N CENTRAL INDEX KEY: 0001279592 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37772 FILM NUMBER: 161672541 MAIL ADDRESS: STREET 1: ONE SANSOME STREET STREET 2: SUITE 3630 CITY: SAN FRANCISCO STATE: CA ZIP: 94104 4 1 v440803_4.xml OWNERSHIP DOCUMENT X0306 4 2016-05-23 0 0001429386 PHASERX, INC. PZRX 0001266567 ATWOOD BRIAN G C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 1 0 1 0 0001456587 Versant Ventures III, LLC C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001456585 Versant Side Fund III, L.P. C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001456586 Versant Venture Capital III, L.P. C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001201580 COLELLA SAMUEL D C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001181338 JAFFE ROSS A MD C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001228684 LINK WILLIAM J PHD C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001279592 LUBASH BARBARA N C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001279660 MILDER DONALD B C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 0001456588 Praeger Robin L. C/O VERSANT VENTURES ONE SANSOME STREET, SUITE 3630 SAN FRANCISCO CA 94104 0 0 1 0 Common Stock 2016-05-23 4 S 0 435 0.01 D 8965 I By Versant Side Fund III, L.P. Common Stock 2016-05-23 4 S 0 1080 0.01 D 7885 I By Versant Side Fund III, L.P. Common Stock 2016-05-23 4 P 0 3523 5.00 A 11408 I By Versant Side Fund III, L.P. Common Stock 2016-05-23 4 S 0 73615 0.01 D 1517531 I By Versant Venture Capital III, L.P. Common Stock 2016-05-23 4 S 0 182914 0.01 D 1334617 I By Versant Venture Capital III, L.P. Common Stock 2016-05-23 4 P 0 596477 5.00 A 1931094 I By Versant Venture Capital III, L.P. Common stock held of record, respectively, by each of Versant Side Fund III, L.P. and Versant Venture Capital III, L.P., (the "Versant Venture Funds"). Versant Ventures III, LLC is the general partner of the Versant Venture Funds and has voting and dispositive control over securities held by the Versant Venture Funds. Brian G. Atwood, Samuel D. Colella, Ross Jaffe, M.D., William J. Link, Barbara N. Lubash, Donald B. Milder, Bradley J. Bolzon, Charles M. Warden, Robin L. Praeger and Rebecca R. Robertson are the managing directors of Versant Ventures III, LLC and are deemed to have voting and dispositive power over the shares and may be deemed to beneficially own shares held by the Versant Venture Funds. Brian G. Atwood is a managing member of and owns an interest in Versant Ventures III, LLC. Accordingly, Brian G. Atwood may be deemed to beneficially own the securities held by the Versant Venture Funds. Each of Brian G. Atwood, Samuel D. Colella, Ross Jaffe, M.D., William J. Link, Barbara N. Lubash, Donald B. Milder, Bradley J. Bolzon, Charles M. Warden, Robin L. Praeger and Rebecca R. Robertson disclaims beneficial ownership of these securities except to the extent of their pecuniary interest therein. This Form 4 is the first of two filings by Brian G. Atwood. Rebecca R. Robertson, Charles M. Warden and Bradley J. Bolzon (the "Other Filers") are also reporting persons. Since the SEC's filing system will not accept CIK and CCC codes from more than ten joint filers of a report, the Other Filers have filed a separate Form 4 that relates to the same securities reported herein. Thus, in total, there are 13 joint filers: the Other Filers and each person that is a signatory to this Form 4. /s/ ROBIN L. PRAEGER, as Managing Director of Versant Ventures III, LLC 2016-05-24 /s/ ROBIN L. PRAEGER, as Managing Director of Versant Ventures III, LLC the General Partner of Versant Side Fund III, L.P. 2016-05-24 /s/ ROBIN L. PRAEGER, as Managing Director of Versant Ventures III, LLC the General Partner of Versant Venture Capital III, L.P. 2016-05-24 /s/ ROBIN L. PRAEGER as Attorney-in-Fact for Brian Atwood 2016-05-24 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Samuel D. Colella 2016-05-24 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Ross Jaffe, M.D 2016-05-24 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for William J. Link 2016-05-24 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Barbara N. Lubash 2016-05-24 /s/ ROBIN L. PRAEGER, as Attorney-in-Fact for Donald B. Milder 2016-05-24 /s/ Robin L. Praeger 2016-05-24