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) 03/19/2013 |
3. Issuer Name and Ticker or Trading Symbol
TETRAPHASE PHARMACEUTICALS INC [ TTPH ] |
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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 | 10,345(1)(4) | D |
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 | ||||
Series A-1 Convertible Participating preferred Stock | (2) | (3) | Common Stock | 72,069(2)(4) | (2) | D | |
Series A-2 Convertible Participating preferred Stock | (2) | (3) | Common Stock | 94,003(2)(4) | (2) | D | |
Series B Convertible Participating preferred Stock | (2) | (3) | Common Stock | 393,864(2)(4) | (2) | D | |
Series C Convertible Participating preferred Stock | (2) | (3) | Common Stock | 938,853(2)(4) | (2) | D |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
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Explanation of Responses: |
1. Reflects a one-for-twenty-nine reverse stock split effected on March 5, 2013. |
2. Convertible into Common Stock on a 1-for-29 basis without payment of further consideration. Each share will automatically convert into 1/29th of a share of Common Stock upon the closing of the Issuer's initial public offering. |
3. Not Applicable |
4. Skyline Venture Management IV, LLC is the General Partner of Skyline Venture Partners Qualified Purchaser IV L.P. Yasunori Kaneko is a Managing Director of Skyline Venture Management IV, LLC. Skyline Venture Management IV, LLC and this individual may be deemed to share voting and dispositive power with respect to all shares held by Skyline Venture Partners Qualified Purchaser IV L.P. Each of the filing persons disclaims beneficial ownership of the shares except to the extent of any pecuniary interest therein. |
Skyline Venture Partners Qualified Purchaser IV LP By: Skyline Venture Management IV, LLC Its: General Partner By: /s/ John Freund, Its Managing Director | 03/19/2013 | |
David C. Lubner (as attorney-in-fact for Yasunori Kaneko) | 03/19/2013 | |
Skyline Venture Management IV, LLC By: /s/ John Freund, Its Managing Director | 03/19/2013 | |
** 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. |