SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response: 0.5
X
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Merck Capital Ventures LLC

(Last) (First) (Middle)
ONE MERCK DRIVE
P.O. BOX 1000

(Street)
WHITEHOUSE STATION NJ 08889

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
HTG MOLECULAR DIAGNOSTICS, INC [ HTGM ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
05/11/2015
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 05/11/2015 C 125,327(1) A (1) 125,327 D
Common Stock 05/11/2015 C 90,494(1) A (1) 215,821 D
Common Stock 05/11/2015 C 192,373(1) A (1) 408,194 D
Common Stock 05/11/2015 C 70,898(1) A (1) 479,092 D
Common Stock 05/11/2015 C 1,963(1) A (2) 481,055 D
Common Stock 05/11/2015 J(3) 55,377 A $14 536,432 D
Common Stock 05/11/2015 J(4) 52,929 A $0.00 589,361 D
Common Stock 05/11/2015 P(5) 167,343 A $14 756,704 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series C-1 Convertible Preferred Stock (1) 05/11/2015 C 8,670,520 (1) (1) Common Stock 125,327 $0.00 0 D
Series C-2 Convertible Preferred Stock (1) 05/11/2015 C 9,601,924 (1) (1) Common Stock 90,494 $0.00 0 D
Series D Convertible Preferred Stock (1) 05/11/2015 C 20,658,958 (1) (1) Common Stock 192,373 $0.00 0 D
Series E Convertible Preferred Stock (1) 05/11/2015 C 7,613,826 (1) (1) Common Stock 70,898 $0.00 0 D
Series D Convertible Preferred Stock Warrant (right to buy) (2) 05/11/2015 X(2) 210,893 07/30/2010 07/29/2020 Series D Convertible Preferred Stock 210,893(2) $0.00 0 D
Series D Convertible Preferred Stock (6) 05/11/2015 X(2) 210,893 (6) (6) Common Stock 1,963 $0.00 210,893 D
Series D Convertible Preferred Stock (1) 05/11/2015 C 210,893 (1) (1) Common Stock 1,963 $0.00 0 D
Series E Convertible Preferred Stock Warrant (right to buy) $0.2189 05/11/2015 C(7) 1,818,681 01/14/2015 01/14/2022 Series E Convertible Preferred Stock 1,818,681 $0.00 0 D
Common Warrant (right to buy) $14 05/11/2015 C(7) 28,436(7) 01/14/2015 01/14/2022 Common Stock 28,436 $0.00 28,436 D
1. Name and Address of Reporting Person*
Merck Capital Ventures LLC

(Last) (First) (Middle)
ONE MERCK DRIVE
P.O. BOX 1000

(Street)
WHITEHOUSE STATION NJ 08889

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
Senour Lawrence D.

(Last) (First) (Middle)
ONE MERCK DRIVE
PO BOX 1000

(Street)
WHITEHOUSE STATION NJ 08889

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. Automatic conversion, in connection with the Issuer's initial public offering, of preferred stock into shares of common stock on a 1 for 107.39 basis, after accounting for any applicable antidilution adjustments. The shares have no expiration date.
2. The warrant was net exercised for shares of common stock upon the closing of the Issuer's initial public offering.
3. Represents the conversion of outstanding promissory notes in the principal amount of $767,719.83, plus accrued interest, into shares of the Issuer's common stock upon closing of the Issuer's initial public offering at a conversion price of $14.00 per share.
4. On April 23, 2015, the Board of Directors of the Issuer declared a dividend payable to all holders of the Series D Convertible Preferred Stock and Series E Convertible Preferred Stock of the Issuer payable in the form of shares of Common Stock of the Issuer. The dividends were issued in connection with the closing of the Issuer's initial public offering.
5. The shares were purchased at the Issuer's initial public offering.
6. The shares of Series D Convertible Preferred Stock have no expiration date and are convertible at any time at the election of the holder without payment of further consideration. Each share of Series D Convertible Preferred Stock will automatically convert on a 1 for 107.39 basis into shares of Common Stock upon the closing of the Issuer's initial public offering.
7. Pursuant to the terms of the warrant, effective upon the closing of the Issuer's initial public offering, the warrant became exercisable for the number of shares of common stock shown above at an exercise price equal to $14.00 per share.
Remarks:
/s/ Sunil Patel, AVP, Corporate Development 05/13/2015
/s/ Lawrence D. Senour 05/13/2015
** 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 4 (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.