0001209191-11-042502.txt : 20110804 0001209191-11-042502.hdr.sgml : 20110804 20110804171536 ACCESSION NUMBER: 0001209191-11-042502 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20110802 FILED AS OF DATE: 20110804 DATE AS OF CHANGE: 20110804 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Johann Peter CENTRAL INDEX KEY: 0001369942 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35238 FILM NUMBER: 111011315 MAIL ADDRESS: STREET 1: C/O NGN CAPITAL BERGHEIMER STR. 89A CITY: HEIDELBERG STATE: 2M ZIP: D69115 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HORIZON PHARMA, INC. CENTRAL INDEX KEY: 0001492426 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 272179987 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1033 SKOKIE BLVD STREET 2: SUITE 355 CITY: NORTHBROOK STATE: IL ZIP: 60062 BUSINESS PHONE: 224-383-3000 MAIL ADDRESS: STREET 1: 1033 SKOKIE BLVD STREET 2: SUITE 355 CITY: NORTHBROOK STATE: IL ZIP: 60062 4 1 doc4.xml FORM 4 SUBMISSION X0304 4 2011-08-02 0 0001492426 HORIZON PHARMA, INC. HZNP 0001369942 Johann Peter C/O HORIZON PHARMA, INC. 1033 SKOKIE BLVD., SUITE 355 NORTHRIDGE IL 60062 1 0 0 0 Common Stock 2011-08-02 4 C 0 401927 A 401927 I See FN Common Stock 2011-08-02 4 C 0 555956 A 957883 I See FN Common Stock 2011-08-02 4 C 0 44364 A 1002247 I See FN Common Stock 2011-08-02 4 C 0 61366 A 1063613 I See FN Common Stock 2011-08-02 4 C 0 89652 9.00 A 1153265 I See FN Common Stock 2011-08-02 4 C 0 124007 9.00 A 1277272 I See FN Common Stock 2011-08-02 4 P 0 81671 9.00 A 1358943 I See FN Common Stock 2011-08-02 4 P 0 112968 9.00 A 1471911 I See FN Common Stock 1523642 I See FN Common Stock 1595198 I See FN Series A Convertible Preferred Stock 2011-08-02 4 C 0 401927 0.00 D Common Stock 401927 0 I See FN Series A Convertible Preferred Stock 2011-08-02 4 C 0 555956 0.00 D Common Stock 555956 0 I See FN Series B Convertible Preferred Stock 2011-08-02 4 C 0 44364 0.00 D Common Stock 44364 0 I See FN Series B Convertible Preferred Stock 2011-08-02 4 C 0 61366 0.00 D Common Stock 61366 0 I See FN Convertible Promissory Notes 9.00 2011-08-02 4 C 0 806879.04 0.00 D Common Stock 89652 0 I See FN Convertible Promissory Notes 9.00 2011-08-02 4 C 0 1116079.76 0.00 D Common Stock 124007 0 I See FN Automatic conversion, in connection with the Issuer's initial public offering, of preferred stock into shares of common stock. Every 2.374 shares of preferred stock converted into one share of common stock upon the closing of the Issuer's initial public offering. The securities are held of record by NGN Biomed Opportunity I GmbH & Co. Beteiligungs KG ("NGN Biomed"). The reporting person is a Managing General Partner of NGN Capital LLC, which is the general partner of the general partner of NGN BioMed and is the managing limited partner of NGN BioMed GMBH. The Reporting Person disclaims beneficial ownership with respect to these securities, except to the extent of his pecuniary interest therein. The securities are held of record by NGN Biomed Opportunity I, L.P. ("NGN Biomed"). Represents shares acquired upon conversion, in connection with the Issuer's initial public offering, of convertible promissory notes. These securities are preferred stock of the Issuer and did not have an expiration date. Prior to the Issuer's initial public offering of common stock, the securities were convertible at any time at the election of the holder. The securities automatically converted into shares of common stock upon the closing of the issuer's initial public offering of common stock. Principal and accrued interest converted upon the Issuer's initial public offering of common stock, into shares of common stock. /s/ Robert J. De Vaere, Attorney-in-Fact 2011-08-04