SEC Form 3
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*
Zaffaroni Alejandro A

(Last) (First) (Middle)
4005 MIRANDA AVE.
#180

(Street)
PALO ALTO CA 94304

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
03/08/2006
3. Issuer Name and Ticker or Trading Symbol
Alexza Pharmaceuticals Inc. [ ALXA ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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 18,181 D
Common Stock 127,272 I By the Zaffaroni Partners, L.P.(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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
Series A Preferred Stock (2) (2) Common Stock 123,000(2) (2) D
Series A Preferred Stock (2) (2) Common Stock 123,000(2) (2) I Held by his spouse
Series B Preferred Stock (3) (3) Common Stock 27,500(3) (3) D
Series B Preferred Stock (3) (3) Common Stock 27,500(3) (3) I Held by his spouse
Series B Preferred Stock (3) (3) Common Stock 1,094,864(3) (3) I Held by the Lida Zaffaroni 2005 Annuity Trust #1(4)
Series B Preferred Stock (3) (3) Common Stock 1,092,226(3) (3) I By the Silveira Irrevocable Trust u/a/d 7/29/87, as co-trustee with his spouse
Series C Preferred Stock (5) (5) Common Stock 20,000(5) (5) D
Series C Preferred Stock (5) (5) Common Stock 20,000(5) (5) I Held by his spouse
Series D Preferred Stock (6) (6) Common Stock 34,000(6) (6) D
Series D Preferred Stock (6) (6) Common Stock 34,000(6) (6) I Held by his spouse
Series D Preferred Stock (6) (6) Common Stock 795,860(6) (6) I Held by the Lida Zaffaroni 2005 Annuity Trust #1(4)
Series D Preferred Stock (6) (6) Common Stock 795,262(6) (6) I By the Silveira Irrevocable Trust u/a/d 7/29/87, as co-trustee with spouse
Series D Preferred Stock (6) (6) Common Stock 780,000(6) (6) I By the Zaffaroni Partners, L.P.(1)
Explanation of Responses:
1. The Reporting Person and his spouse are general and limited partners of Zaffaroni Partners, L.P. As a partner, the Reporting Person and his spouse may be deemed to have indirect beneficial ownership of the shares owned by Zaffaroni Partners, L.P. The Reporting Person disclaims beneficial ownership of such shares held by Zaffaroni Partners, L.P. except to the extent of his pecuniary interest arising therein.
2. The Issuer's preferred stock will automatically be converted into Common Stock upon the closing of the Issuer's initial public offering. The number of shares does not reflect the automatic conversion of each share of Series A Preferred Stock into 0.186 shares of Common Stock upon the closing of the initial public offering.
3. The Issuer's preferred stock will automatically be converted into Common Stock upon the closing of the Issuer's initial public offering. The number of shares does not reflect the automatic conversion of each share of Series B Preferred Stock into 0.192 shares of Common Stock upon the closing of the initial public offering.
4. The shares are held by the Lida Zaffaroni 2005 Annuity Trust #1, of which the Reporting Person's spouse holds a pecuniary interest in the annuity provided for in the trust agreement.
5. The Issuer's preferred stock will automatically be converted into Common Stock upon the closing of the Issuer's initial public offering. The number of shares does not reflect the automatic conversion of each share of Series C Preferred Stock into 0.202 shares of Common Stock upon the closing of the initial public offering.
6. The Issuer's preferred stock will automatically be converted into Common Stock upon the closing of the Issuer's initial public offering. The number of shares does not reflect the automatic conversion of each share of Series D Preferred Stock into 0.182 shares of Common Stock upon the closing of the initial public offering.
/s/ Alejandro A. Zaffaroni 03/08/2006
** 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.
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