0001209191-14-028931.txt : 20140423 0001209191-14-028931.hdr.sgml : 20140423 20140423191345 ACCESSION NUMBER: 0001209191-14-028931 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140423 FILED AS OF DATE: 20140423 DATE AS OF CHANGE: 20140423 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: VITAL THERAPIES INC CENTRAL INDEX KEY: 0001280776 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 15222 AVENUE OF SCIENCE, SUITE B CITY: SAN DIEGO STATE: CA ZIP: 92128 BUSINESS PHONE: 858-673-6840 MAIL ADDRESS: STREET 1: 15222 AVENUE OF SCIENCE, SUITE B CITY: SAN DIEGO STATE: CA ZIP: 92128 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Godshall Douglas Evan CENTRAL INDEX KEY: 0001404227 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36201 FILM NUMBER: 14779808 MAIL ADDRESS: STREET 1: SUITE 4 LEVEL 46 2 PARK STREET CITY: SIDNEY STATE: C3 ZIP: 2000 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-04-23 0 0001280776 VITAL THERAPIES INC VTL 0001404227 Godshall Douglas Evan C/O VITAL THERAPIES, INC. 15010 AVENUE OF SCIENCE, SUITE 200 SAN DIEGO CA 92128 1 0 0 0 Common Stock 2014-04-23 4 P 0 12500 12.00 A 12500 D Common Stock 2014-04-23 4 C 0 54018 A 66518 D Senior Convertible Preferred Stock 2014-04-23 4 C 0 54018 0.00 D Common Stock 54018 0 D Each share of Senior Convertible Preferred Stock automatically converted into the Registrant's common stock on a one-for-one basis immediately prior to the closing of the Registrant's initial public offering and had no expiration date. /s/ Michael V. Swanson, by power of attorney 2014-04-23