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) 03/20/2014 |
3. Issuer Name and Ticker or Trading Symbol
Versartis, Inc. [ VSAR ] |
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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) |
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 Convertible Preferred Stock | (1) | (2) | Common Stock | 866,611 | (1) | D(3) | |
Series A Convertible Preferred Stock | (1) | (2) | Common Stock | 82,259 | (1) | D(4) | |
Series A Convertible Preferred Stock | (1) | (2) | Common Stock | 7,652 | (1) | D(5) | |
Series B Convertible Preferred Stock | (1) | (2) | Common Stock | 697,149 | (1) | D(3) | |
Series B Convertible Preferreed Stock | (1) | (2) | Common Stock | 66,173 | (1) | D(4) | |
Series B Convertible Preferred Stock | (1) | (2) | Common Stock | 6,155 | (1) | D(5) | |
Series C Convertible Preferred Stock | (1) | (2) | Common Stock | 642,566 | (1) | D(3) | |
Series C Convertible Preferred Stock | (1) | (2) | Common Stock | 60,994 | (1) | D(4) | |
Series C Convertible Preferred Stock | (1) | (2) | Common Stock | 5,673 | (1) | D(5) | |
Series D-1 Convertible Preferred Stock | (1) | (2) | Common Stock | 128,413 | (1) | D(3) | |
Series D-1 Convertible Preferred Stock | (1) | (2) | Common Stock | 12,189 | (1) | D(4) | |
Series D-1 Convertible Preferred Stock | (1) | (2) | Common Stock | 1,134 | (1) | D(5) | |
Series D-2 Convertible Preferred Stock | (1) | (2) | Common Stock | 57,071 | (1) | D(3) | |
Series D-2 Convertible Preferred Stock | (1) | (2) | Common Stock | 5,417 | (1) | D(4) | |
Series D-2 Convertible Preferred Stock | (1) | (2) | Common Stock | 506 | (1) | D(5) | |
Warrant to Purchase Series B Convertible Preferred Stock | (6) | (7) | Series B Convertible Preferred Stock | 665,057 | $0.45 | D(3) | |
Warrant to Purchase Series B Convertible Preferred Stock | (6) | (7) | Series B Convertible Preferred Stock | 63,127 | $0.45 | D(4) | |
Warrant to Purchase Series B Convertible Preferred Stock | (6) | (7) | Series B Convertible Preferred Stock | 5,872 | $0.45 | D(5) |
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. In connection with the completion of the Issuer's initial public offering of Common Stock, each share of Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock, Series D-1 Convertible Preferred Stock, Series D-2 Convertible Preferred Stock and Series E Convertible Preferred Stock shall automatically convert into Common Stock on a 1-for-11.5 basis. |
2. Not applicable. |
3. The securities are held by Index Ventures IV (Jersey) L.P. ("Index Ventures IV"). Index Venture Associates IV Limited is the general partner of Index Ventures IV. Paul Willing, Sinead Meehan, David Hall, Bernard Dalle and Phil Balderson are directors of Index Venture Associates IV Limited. Messrs. Willing, Hall, Dalle, Balderson and Ms. Meehan share voting and dispositive power with respect to the securities. Each of these persons disclaims beneficial ownership of these securities except to the extent of his or her pecuniary interest therein. |
4. The securities are held by Index Ventures IV Parallel Entrepreneur Fund (Jersey) L.P. ("Index Entrepreneur Fund"). Index Venture Associates IV Limited is the general partner of Index Entrepreneur Fund. Paul Willing, Sinead Meehan, David Hall, Bernard Dalle and Phil Balderson are directors of Index Venture Associates IV Limited. Messrs. Willing, Hall, Dalle, Balderson and Ms. Meehan share voting and dispositive power with respect to the securities. Each of these persons disclaims beneficial ownership of these securities except to the extent of his or her pecuniary interest therein. |
5. The securities are held by Yucca (Jersey) SLP ("Yucca"). The corporate general partner of Yucca is Yucca Associates Limited. Messrs. Nigel T. Greenwood and Ian J. Henderson are directors of Yucca Associates Limited and share voting and dispositive power with respect to the securities held by Yucca. Each of these persons disclaims beneficial ownership of these securities except to the extent of his pecuniary interest therein. |
6. In connection with the completion of the Issuer's initial public offering of Common Stock the warrant to purchase Series B Convertible Preferred Stock shall automatically convert into a warrant to purchase Common Stock on a 1-for-11.5 basis. |
7. The warrant shall expire on the earlier of October 12, 2017 or the closing of the Issuer's initial public offering. |
Remarks: |
/s/Charles Le Cornu, Alternate Director Index Ventures IV (Jersey), L.P. By: Its Managing General Partner Index Venture Associates Limited | 03/20/2014 | |
/s/ Index Venture Assocaites IV Limited, its Managing General Partner, By: Charles Le Cornu, Alternate Director | 03/20/2014 | |
/s/ Ogier Employee Benefit Services Llimited, authorized signatory of Yucca (Jersey) SLP in its capacity as administrator of Index Co-Investment scheme, By: Charles Le Cornu, authorized signatory | 03/20/2014 | |
** 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. |